Active NPI
Tiana Gunnar Mick, RD
- Registered Dietitian
- Edina, MN
National Provider Identifier
1629850128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 5072
- Practice address
- 3250 W 66TH St Apt 548
Edina, MN 55435-5514 - Phone
- (502) 382-0927
- NPI assigned
- Oct 18, 2023
- 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 | 5072 | MN | Primary |
Addresses
Primary practice location
3250 W 66TH St Apt 548
Edina, MN 55435-5514
Mailing address
444 Victory Ave Apt 307
Sartell, MN 56377-4823
Phone (320) 333-8226
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5072 | MN | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bradley Management LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697587200000",
"number": "1629850128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "444 VICTORY AVE APT 307",
"city": "SARTELL",
"state": "MN",
"postal_code": "563774823",
"telephone_number": "320-333-8226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3250 W 66TH ST APT 548",
"city": "EDINA",
"state": "MN",
"postal_code": "554355514",
"telephone_number": "502-382-0927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICK",
"first_name": "TIANA",
"middle_name": "GUNNAR",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-18",
"last_updated": "2023-10-18",
"certification_date": "2023-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "5072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.