Provider Demographics
NPI:1891760799
Name:GREENWALDT, HEIDI JO (MS, RD, LD, CNSD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:GREENWALDT
Suffix:
Gender:F
Credentials:MS, RD, LD, CNSD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:VERPY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 84
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-273-3216
Mailing Address - Fax:612-273-5039
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 84
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-273-3216
Practice Address - Fax:612-273-5039
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
710000441Medicare ID - Type Unspecified