Provider Demographics
NPI:1467061291
Name:BJERKE NUTRITION AND WELLNESS, LLC
Entity Type:Organization
Organization Name:BJERKE NUTRITION AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BJERKE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:507-774-0699
Mailing Address - Street 1:1880 AUSTIN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4544
Mailing Address - Country:US
Mailing Address - Phone:507-774-0699
Mailing Address - Fax:888-490-2036
Practice Address - Street 1:1880 AUSTIN RD STE 1
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4544
Practice Address - Country:US
Practice Address - Phone:507-774-0699
Practice Address - Fax:888-490-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty