Provider Demographics
NPI:1952621245
Name:ERNSTE, SCOTT MATTHEW (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MATTHEW
Last Name:ERNSTE
Suffix:
Gender:M
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26694 483RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-7230
Mailing Address - Country:US
Mailing Address - Phone:952-454-4666
Mailing Address - Fax:
Practice Address - Street 1:26694 483RD AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-7230
Practice Address - Country:US
Practice Address - Phone:952-454-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
965851133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
965851OtherCOMMISSION ON DIETETIC REGISTRATION LICENSURE NUMBER