Individual
JACQUELINE WIVINUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Contact information
Practice address
1 VETERANS DR, MINNEAPOLIS, MN 55417-2309
(763) 370-1487
Mailing address
7565 ORCHID LN N, MAPLE GROVE, MN 55311-2603
(763) 370-1487
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
3777
MN
Other
Enumeration date
04/04/2023
Last updated
04/04/2023
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