Provider Demographics
NPI:1922760933
Name:MATTHIES, DANIELLE R (RD, CD, LD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:MATTHIES
Suffix:
Gender:F
Credentials:RD, CD, LD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:R
Other - Last Name:ASHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2370 LEXINGTON AVE S APT 316
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1245
Mailing Address - Country:US
Mailing Address - Phone:920-585-3427
Mailing Address - Fax:
Practice Address - Street 1:1500 CENTRAL PARK COMMONS DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-8702
Practice Address - Country:US
Practice Address - Phone:515-695-3018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered