Provider Demographics
NPI:1558699868
Name:FROEMKE, CARLIE L (LRD)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:L
Last Name:FROEMKE
Suffix:
Gender:F
Credentials:LRD
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:L
Other - Last Name:AMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:737 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4421
Mailing Address - Country:US
Mailing Address - Phone:701-234-5884
Mailing Address - Fax:701-234-6085
Practice Address - Street 1:737 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4421
Practice Address - Country:US
Practice Address - Phone:701-234-5884
Practice Address - Fax:701-234-6085
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND772133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered