Provider Demographics
NPI:1639224975
Name:NIEDENTHAL-DURET, DEANNA M (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:M
Last Name:NIEDENTHAL-DURET
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:M
Other - Last Name:DURET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 ELM STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359
Mailing Address - Country:US
Mailing Address - Phone:320-532-3154
Mailing Address - Fax:320-532-3111
Practice Address - Street 1:200 ELM STREET NORTH
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359
Practice Address - Country:US
Practice Address - Phone:320-532-3154
Practice Address - Fax:320-532-3111
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001831133V00000X
WI5377133V00000X
MN3924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8448821Medicaid