Provider Demographics
NPI:1215971213
Name:PATEFIELD, AMY (RD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PATEFIELD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 314N
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1052
Mailing Address - Country:US
Mailing Address - Phone:651-645-5323
Mailing Address - Fax:651-647-5135
Practice Address - Street 1:1660 HIGHWAY 100 S
Practice Address - Street 2:SUITE 250
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1529
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:952-746-5962
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2319133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered