Provider Demographics
NPI:1821505835
Name:GENELIN, MEGAN JEAN (RD, LD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JEAN
Last Name:GENELIN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24474 361ST AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:MN
Mailing Address - Zip Code:56044-3423
Mailing Address - Country:US
Mailing Address - Phone:507-560-0054
Mailing Address - Fax:
Practice Address - Street 1:100 FREEMAN DR
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-3504
Practice Address - Country:US
Practice Address - Phone:507-985-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3927133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered