Provider Demographics
NPI:1710227772
Name:ANDERSON, KAITLIN MARIE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 37TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3404
Mailing Address - Country:US
Mailing Address - Phone:507-289-0266
Mailing Address - Fax:507-289-9271
Practice Address - Street 1:500 37TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3404
Practice Address - Country:US
Practice Address - Phone:507-289-0266
Practice Address - Fax:507-289-9271
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2827133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered