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Contact Information

MARY M BAZILLE, RD
2450 RIVERSIDE AVE
MINNEAPOLIS, MN55454-1450
 Phone: 612-273-4395
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nutritionist

133N00000X
Indicates primary specialty

NPI Profile & details for MARY M BAZILLE · (Female)

NPI # 1700042702
Status Active
Credentials RD (Registered Dietitian)
Entity Individual
Enumeration date 07/30/2008
Last updated 12/28/2010 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • VA License # 994556
  • VA Medicaid 004909976
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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