Provider Demographics
NPI:1831782242
Name:SKARDA, KATIE (RDN, LRD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SKARDA
Suffix:
Gender:F
Credentials:RDN, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BURDICK EXPY W STE 202
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4406
Mailing Address - Country:US
Mailing Address - Phone:701-857-2836
Mailing Address - Fax:
Practice Address - Street 1:1015 S BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4667
Practice Address - Country:US
Practice Address - Phone:701-857-5268
Practice Address - Fax:701-857-5593
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1202133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered