Provider Demographics
NPI:1184694127
Name:FUNDINGSLAND, MICHELLE JOY (RD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOY
Last Name:FUNDINGSLAND
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JOY
Other - Last Name:TORNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-857-2850
Mailing Address - Fax:701-857-5593
Practice Address - Street 1:400 BURDICK EXPY E FL 1
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4768
Practice Address - Country:US
Practice Address - Phone:701-857-2850
Practice Address - Fax:701-857-5593
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND678133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered