Individual
LISA MARIE KUKLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
601 BUNKER HILL DR, AITKIN, MN 56431-1864
(218) 927-5520
(218) 429-3972
Mailing address
1593 EVERGREEN DR, CLOQUET, MN 55720-8510
(218) 740-4060
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2603
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
876393
ADA MEMBER NUMBER
MN
Enumeration date
10/03/2006
Last updated
02/04/2008
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