Provider Demographics
NPI:1124239843
Name:BUCK, DORIE MARIAN (CNHP)
Entity type:Individual
Prefix:
First Name:DORIE
Middle Name:MARIAN
Last Name:BUCK
Suffix:
Gender:F
Credentials:CNHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SPRUCE ST NE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-1260
Mailing Address - Country:US
Mailing Address - Phone:320-587-4673
Mailing Address - Fax:320-587-4673
Practice Address - Street 1:720 SPRUCE ST NE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1260
Practice Address - Country:US
Practice Address - Phone:320-587-4673
Practice Address - Fax:320-587-4673
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2789237133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education