Provider Demographics
NPI:1548558224
Name:BALGIE, PAIGE LYNN (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:PAIGE
Middle Name:LYNN
Last Name:BALGIE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:LYNN
Other - Last Name:GUSTAFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:NUTRITION SERVICES
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-3740
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:NUTRITION SERVICES
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3005133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered