Individual
BRAD KITTELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LRD
Contact information
Practice address
1720 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 280-4474
Mailing address
PO BOX 2168, FARGO, ND 58107-2168
(701) 234-2119
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
397
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56318
—
ND
Enumeration date
12/24/2013
Last updated
03/25/2014
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