Active NPI
Mary Hagstrom, RD, LD
- Registered Dietitian
- Fergus Falls, MN
National Provider Identifier
1154957462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 4292
- Practice address
- 712 Cascade St S
Fergus Falls, MN 56537 - Phone
- (218) 736-8059
- NPI assigned
- Mar 18, 2020
- 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 Dietitian | 133V00000X | 4292 | MN | Primary |
Addresses
Primary practice location
712 Cascade St S
Fergus Falls, MN 56537
Mailing address
712 Cascade St S
Fergus Falls, MN 56537
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | unknown |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584489600000",
"number": "1154957462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 CASCADE ST S",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "56537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 CASCADE ST S",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "56537",
"telephone_number": "218-736-8059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGSTROM",
"first_name": "MARY",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-18",
"last_updated": "2020-03-18",
"certification_date": "2020-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "4292",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "unknown",
"affiliation": "N",
"address_1": "712 S Cascade St",
"city": "Fergus Falls",
"state": "MN",
"country_code": "US",
"postal_code": "565372913",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fergus Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.