Provider Demographics
NPI:1295240786
Name:THOMSEN, KATHERINE CAROLINE (RDN/LN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CAROLINE
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:RDN/LN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:CAROLINE
Other - Last Name:ANUNDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN/LN
Mailing Address - Street 1:525 N FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2966
Mailing Address - Country:US
Mailing Address - Phone:605-995-5790
Mailing Address - Fax:
Practice Address - Street 1:525 N FOSTER ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2966
Practice Address - Country:US
Practice Address - Phone:605-995-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0580133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered