Organization
HEALTHENUTRIFIT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN MARIANNE PARKS RD, CSSD,LN (CEO/LICENSED RD)
(651) 592-7830
Entity
Organization
Contact information
Practice address
750 MAIN ST, SUITE 100, MENDOTA HEIGHTS, MN 55118-3764
(651) 592-7830
(651) 405-3850
Mailing address
2282 FIELD STONE DRIVE, MENDOTA HEIGHTS, MN 55120-1918
(651) 592-7830
(651) 405-3850
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
172V00000X
Community Health Worker
—
—
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
400A2PA
BCBS OF MN
MN
05
—
491211000
—
MN
Enumeration date
02/22/2008
Last updated
02/01/2013
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