Provider Demographics
NPI:1427482892
Name:ANDERSON, DONA BERANEK (RD LD)
Entity type:Individual
Prefix:
First Name:DONA
Middle Name:BERANEK
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:DONA
Other - Middle Name:JEAN
Other - Last Name:WIECKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:CENTRACARE CLINIC
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRACARE CIR # 2400
Practice Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA/GASTROENTEROLOGY
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered