Provider Demographics
NPI:1245764604
Name:FERRIS, HEIDI (RD,CDE,)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:FERRIS
Suffix:
Gender:F
Credentials:RD,CDE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 MANKATO AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6435
Mailing Address - Country:US
Mailing Address - Phone:507-457-7645
Mailing Address - Fax:
Practice Address - Street 1:859 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6435
Practice Address - Country:US
Practice Address - Phone:507-457-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered