Individual
KIMBERLY SUE ROLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LRD
Contact information
Practice address
2101 ELM ST N, FARGO, ND 58102-2417
(701) 239-3700
(701) 239-3705
Mailing address
20569 OAKDALE RD, UNDERWOOD, MN 56586-9598
(701) 361-5970
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
409
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
409
STATE LISCENSE NUMBER
ND
Enumeration date
07/11/2006
Last updated
01/28/2020
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