Provider Demographics
NPI:1316449705
Name:BERENTSON, ERIN (MPH, RDN, LRD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BERENTSON
Suffix:
Gender:F
Credentials:MPH, RDN, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:WESTHOPE
Mailing Address - State:ND
Mailing Address - Zip Code:58793-0311
Mailing Address - Country:US
Mailing Address - Phone:701-871-2218
Mailing Address - Fax:
Practice Address - Street 1:314 5TH ST W STE 3
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-1204
Practice Address - Country:US
Practice Address - Phone:701-871-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
ND936133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered