Provider Demographics
NPI:1497709851
Name:MERRITT, HEATHER J (RD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:J
Last Name:MERRITT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:J
Other - Last Name:NIEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4801 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2015
Mailing Address - Country:US
Mailing Address - Phone:320-255-6376
Mailing Address - Fax:320-255-6478
Practice Address - Street 1:4801 VETERANS DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2015
Practice Address - Country:US
Practice Address - Phone:320-255-6376
Practice Address - Fax:320-255-6478
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN913587133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered