Provider Demographics
NPI:1760714133
Name:REISDORF, ELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:REISDORF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:M HEALTH FAIRVIEW CLINIC-FRIDLEY
Mailing Address - Street 2:6341 UNIVERSITY AVE NE
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432
Mailing Address - Country:US
Mailing Address - Phone:763-572-5700
Mailing Address - Fax:763-568-5888
Practice Address - Street 1:M HEALTH FAIRVIEW CLINIC-FRIDLEY
Practice Address - Street 2:6341 UNIVERSITY AVE NE
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-572-5700
Practice Address - Fax:763-568-5888
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered