Provider Demographics
NPI:1932721610
Name:MCPHERSON, DEIRDRE NICOLE (RDN, LDN, CDCES)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:NICOLE
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:RDN, LDN, CDCES
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:NICOLE
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LDN, CDCES
Mailing Address - Street 1:11717 EMERY VILLAGE DR N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2489
Mailing Address - Country:US
Mailing Address - Phone:763-234-6196
Mailing Address - Fax:
Practice Address - Street 1:11717 EMERY VILLAGE DR N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2489
Practice Address - Country:US
Practice Address - Phone:763-234-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1092827133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3465OtherLICENSED DIETITIAN/LICENSED DIETITIAN NUTRITIONIST
32100651OtherCERTIFIED DIABETES CARE AND EDUCATION SPECIALIST
1092827OtherREGISTERED DIETITIAN/REGISTERED DIETITIAN NUTRITIONIST