Provider Demographics
NPI:1417320813
Name:BLAUWET, TERESA (RD, LN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BLAUWET
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 E 10TH ST
Mailing Address - Street 2:HY-VEE 1637
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-2135
Mailing Address - Country:US
Mailing Address - Phone:605-336-8947
Mailing Address - Fax:605-336-9014
Practice Address - Street 1:3020 E 10TH ST
Practice Address - Street 2:HY-VEE 1637
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-2135
Practice Address - Country:US
Practice Address - Phone:605-336-8947
Practice Address - Fax:605-336-9014
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0540133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered