Individual
KATHY A HEITKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDE
Contact information
Practice address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-3300
(701) 364-8906
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
R11357
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15713
NDBS #
ND
01
—
18091
NDBS #
ND
01
—
18092
NDBS #
MN
01
—
18093
NDBS #
MN
01
—
18094
NDBS #
MN
01
—
ND200036
LHS #
ND
Enumeration date
07/13/2006
Last updated
07/08/2007
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