Provider Demographics
NPI:1902634801
Name:INTEGRATED RD CARE
Entity type:Organization
Organization Name:INTEGRATED RD CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIEITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSRDN,LD
Authorized Official - Phone:320-237-5952
Mailing Address - Street 1:19128 66TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:MN
Mailing Address - Zip Code:55340-2001
Mailing Address - Country:US
Mailing Address - Phone:320-237-5952
Mailing Address - Fax:
Practice Address - Street 1:19128 66TH AVE N
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:MN
Practice Address - Zip Code:55340-2001
Practice Address - Country:US
Practice Address - Phone:320-237-5952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty