Individual
LEAH M WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDLD/CDE
Contact information
Practice address
705 PLEASANT AVE S, PARK RAPIDS, MN 56470-1440
(218) 732-2800
(218) 732-2874
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(218) 732-2800
(218) 732-2874
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
1507
MN
133V00000X
Registered Dietitian
Primary
1507
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407897168
—
MN
01
—
15790
NDBS #
MN
01
—
6300061
MEDICA #
MN
01
—
6300062
MEDICA #
MN
01
—
6300063
MEDICA #
MN
01
—
6D677WA
MNBS #
MN
01
—
6D678WA
MNBS #
MN
01
—
6D679WA
MNBS #
MN
Enumeration date
06/10/2006
Last updated
08/08/2012
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