Provider Demographics
NPI:1649486051
Name:KURILLA, ANDREA M (MPH RDN LD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:KURILLA
Suffix:
Gender:F
Credentials:MPH RDN LD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:REICHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5354 PARKDALE DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1603
Mailing Address - Country:US
Mailing Address - Phone:651-645-5323
Mailing Address - Fax:952-746-5962
Practice Address - Street 1:5354 PARKDALE DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1603
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:952-746-5962
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2607133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered