Individual
TARA ETTESTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD, CDE
Contact information
Practice address
600 W 98TH ST, BLOOMINGTON, MN 55420
(952) 885-6235
Mailing address
600 W 98TH ST, BLOOMINGTON, MN 55420
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2873
MN
Other
Enumeration date
10/14/2013
Last updated
11/02/2016
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