Provider Demographics
NPI:1205454766
Name:DISEASE MANAGEMENT AND PREVENTION DIETITIANS PLLC
Entity type:Organization
Organization Name:DISEASE MANAGEMENT AND PREVENTION DIETITIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:LRD, RDN,CDE
Authorized Official - Phone:701-532-1683
Mailing Address - Street 1:1100 19TH AVE N STE 178
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-5906
Mailing Address - Country:US
Mailing Address - Phone:701-532-1683
Mailing Address - Fax:
Practice Address - Street 1:1100 19TH AVE N STE 178
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-5906
Practice Address - Country:US
Practice Address - Phone:701-532-1683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty