Provider Demographics
NPI:1780022202
Name:BJERKE, TRACY KAY (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:KAY
Last Name:BJERKE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:KAY
Other - Last Name:REITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1880 AUSTIN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4544
Mailing Address - Country:US
Mailing Address - Phone:075-774-0699
Mailing Address - Fax:888-490-2036
Practice Address - Street 1:1880 AUSTIN RD STE 1
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4544
Practice Address - Country:US
Practice Address - Phone:507-774-0699
Practice Address - Fax:888-490-2036
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3202133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered