Provider Demographics
NPI:1952572703
Name:MEINECKE, MORGAN KRISTINE (RD , LD)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:KRISTINE
Last Name:MEINECKE
Suffix:
Gender:F
Credentials:RD , LD
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:KRISTINE
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD , LD
Mailing Address - Street 1:3850 PARK NICOLLET BLVD
Mailing Address - Street 2:PARK NICOLLET-FAMILY PRACTICE NUTRITION
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2527
Mailing Address - Country:US
Mailing Address - Phone:952-993-0248
Mailing Address - Fax:
Practice Address - Street 1:3850 PARK NICOLLET BLVD
Practice Address - Street 2:PARK NICOLLET-FAMILY PRACTICE NUTRITION
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2708133V00000X
IA01725133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered