Provider Demographics
NPI:1144525627
Name:GUSTAFSON LUTHI, NANCY J (MS, RD, CDE, CSOWM)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:GUSTAFSON LUTHI
Suffix:
Gender:F
Credentials:MS, RD, CDE, CSOWM
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:GUSTAFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, FADA
Mailing Address - Street 1:2101 ELM ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2417
Mailing Address - Country:US
Mailing Address - Phone:701-239-3700
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-239-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND237133VN1201X, 133V00000X
MN3191133V00000X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management