Provider Demographics
NPI:1407265135
Name:NUTRITIONAL WEIGHT AND WELLNESS
Entity Type:Organization
Organization Name:NUTRITIONAL WEIGHT AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:VIGESAA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:763-221-1981
Mailing Address - Street 1:14223 VALLEY VIEW RD
Mailing Address - Street 2:301
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-1961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18480 KENYON AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6911
Practice Address - Country:US
Practice Address - Phone:952-641-5240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2982133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty