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General NPI Number Information
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NPI Number | 1063057420
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Entity Type | Individual
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Provider Name | KATHLEEN ERIN O'MEARA LN
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Gender | Female
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 7101 YORK AVE S STE 157
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City | EDINA
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State | MN
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Zip | 55435-4420
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Country | US
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Telephone | 612-860-5285
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Fax |
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Provider Business Mailing Address
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Address Line | 1521 KALTERN LN
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City | GOLDEN VALLEY
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State | MN
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Zip | 55416-3507
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | N232
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License Number State | MN
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