Birch Bungalow, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

2913 Issued in MN

Legal business name

BIRCH BUNGALOW, LLC

Doing business as

Real Nutrition

Practice address

25212 County Highway 124
Fergus Falls, MN 56537-8266

Phone

(218) 770-9788

NPI assigned

Apr 3, 2017

Organization subpart

Yes

Parent organization

BIRCH BUNGALOW, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katrina Lea Mouser, RD, LDNPI 1568994655

Title

Owner

Phone

(218) 770-9788

Specialties & licenses 1

Addresses

Other names 1

• Real Nutrition Doing business as

Part of

Birch Bungalow LLC

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katrina Lea Mouser, RD, LD

  • Registered Dietitian
  • Fergus Falls, MN
  • NPI 1568994655
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491177600000",
    "number": "1932631405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25212 COUNTY HIGHWAY 124",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565378266",
            "telephone_number": "218-770-9788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25212 COUNTY HIGHWAY 124",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565378266",
            "telephone_number": "218-770-9788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRCH BUNGALOW, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BIRCH BUNGALOW, LLC",
        "enumeration_date": "2017-04-03",
        "last_updated": "2017-04-03",
        "status": "A",
        "authorized_official_last_name": "MOUSER",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_middle_name": "LEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-770-9788",
        "authorized_official_credential": "RD, LD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "2913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Real Nutrition",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonah Bergstrand, PA-C
• Karen Beseman, BSN,PHN,RN
• Jessica Beske
• Miranda Bettermann
• Bio-Medical Applications of Minnesota, Inc.
• David T Bjork, M.D.
• Jane Mary Bjornson, LICSW
• Susan Black
• Julie E Blaskowski
• Amanda Sue Blonigen

• Clinic/Center in Fergus Falls, MN
• Providers in Fergus Falls, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.