Provider Demographics
NPI:1922647965
Name:BARTELDS, ELISE FRANCES (RD, LD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:FRANCES
Last Name:BARTELDS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:FRANCES
Other - Last Name:VERDEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:608 CRYSTAL LAKE RD E
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-5125
Mailing Address - Country:US
Mailing Address - Phone:612-618-3123
Mailing Address - Fax:
Practice Address - Street 1:17398 EASTWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4826
Practice Address - Country:US
Practice Address - Phone:612-618-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered