Active NPI
Elizabeth A Christopherson
- Registered Dietetic Technician
- St Louis Park, MN
National Provider Identifier
1053570580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietetic Technician
- License
- 1052
- Practice address
- 6500 Excelsior Blvd
St Louis Park, MN 55426 - Phone
- (952) 993-6200
- NPI assigned
- Jun 9, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietetic Technician | 136A00000X | 1052 | MN | Primary |
Addresses
Primary practice location
6500 Excelsior Blvd
St Louis Park, MN 55426
Mailing address
6465 Wayzata Blvd
Suite 210
St Louis Park, MN 55426
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1052 | MN | MD | Registered Dietetic Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212969600000",
"number": "1053570580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6465 WAYZATA BLVD",
"address_2": "SUITE 210",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "55426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6500 EXCELSIOR BLVD",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "55426",
"telephone_number": "952-993-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHRISTOPHERSON",
"first_name": "ELIZABETH",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-09",
"last_updated": "2008-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "136A00000X",
"taxonomy_group": "",
"desc": "Dietetic Technician, Registered",
"state": "MN",
"license": "1052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
- Tayler Joseph Christensen, BA, GRADUATE STUDENT
- Irene Duong Hien Minh Christenson, M.A. CCC-SLP
- Nathan L Christenson, NP
- Kristin Kay Christiansen, M.D.
- Christopher J. Foley D.C. , P.a.
- Jennifer Lee Christy, MS, MT-BC
- Bok Chung, MD
- Nyahon Chieng Chut, PA-C
- Karen Marie Cieminski, P.T.
- Kelly Ann Clancey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.