| Doctor Name: | JAMIE WITHROW |
| NPI Number: | 1013386457 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD,LD,CDE |
| License Number: | 1087979 |
| Business Practice Address: | 320 E Main St Crosby, MN - 564411645 |
| Business Phone Number: | 2185467000 |
| Business Fax Number: | |
| Mailing Address: | 320 E Main St, CROSBY |
| State: | MN |
| Postal Code: | 564411645 |
| Phone Number: | 2185467000 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2015 |
| NPI Last Update Date: | 09/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 136A00000X |
| License Number: | 1087979 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietetic Technician, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person trained in food and nutrition who is an integral part of health care and foodservice management teams. A dietetic technician, registered (DTR) has successfully completed at least a two-year associate |