Individual
TIA M KOCKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDE
Contact information
Practice address
705 PLEASANT AVE S, PARK RAPIDS, MN 56470-1440
(218) 732-2800
(218) 732-2857
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
R33968
MN
Other
Enumeration date
01/07/2010
Last updated
08/08/2012
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