Provider Demographics
NPI:1821597824
Name:WEIRENS, BAILEY ANN (RD)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:ANN
Last Name:WEIRENS
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 1:3144 CHOWEN AVE S APT 305
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5449
Mailing Address - Country:US
Mailing Address - Phone:320-293-2189
Mailing Address - Fax:
Practice Address - Street 1:5201 EDEN AVE STE 300
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2315
Practice Address - Country:US
Practice Address - Phone:508-296-0862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered