Basic Information
| Provider Information | |||||||||
| NPI: | 1174170146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORGRIMSON | ||||||||
| FirstName: | MIRANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1109 DEVONSHIRE CURV | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554313191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182691252 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3525 MONTEREY DR | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554165275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529936466 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2019 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.