Provider Demographics
NPI:1215976360
Name:STOTERAU, KATIE MARIE (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:STOTERAU
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:1110 YANKEE DOODLE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2092
Practice Address - Country:US
Practice Address - Phone:651-454-3970
Practice Address - Fax:651-905-5087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered