Provider Demographics
NPI:1841565041
Name:ENGEL, KATELYN (RD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:ENGEL
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 1:4201 W VALHALLA BLVD APT 26
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-5232
Mailing Address - Country:US
Mailing Address - Phone:612-743-2340
Mailing Address - Fax:
Practice Address - Street 1:4201 W VALHALLA BLVD APT 26
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-5232
Practice Address - Country:US
Practice Address - Phone:612-743-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0414133N00000X
01069099133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist