Individual
MS. SANDRA W RETZLAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LRD
Contact information
Practice address
2101 ELM ST N, FARGO, ND 58102-2417
(701) 239-3745
(701) 237-2485
Mailing address
1126 1ST ST N, FARGO, ND 58102-3730
(701) 232-5799
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
210
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
210
DIETITAN STATE LICENSE
ND
Enumeration date
07/15/2006
Last updated
07/13/2007
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