Healthcare Provider Details

I. General information

NPI: 1790334886
Provider Name (Legal Business Name): KATHRYN CASSELLIUS MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN MAGNUSON

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

876 TIMBER DR
GARNER NC
27529-4850
US

IV. Provider business mailing address

5555 QUAIL AVE N
CRYSTAL MN
55429-3254
US

V. Phone/Fax

Practice location:
  • Phone: 919-803-2285
  • Fax:
Mailing address:
  • Phone: 763-412-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: