Individual
MS. JANICE KAE FORKRUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD, CDE
Contact information
Practice address
502 2ND ST SW, SUITE 1, WILLMAR, MN 56201-3337
(320) 235-7232
Mailing address
502 2ND ST SW, SUITE 1, WILLMAR, MN 56201-3337
(320) 235-7232
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1601
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
710000133
MEDICARE NUMBER
MN
Enumeration date
07/30/2007
Last updated
11/05/2008
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