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General NPI Number Information
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NPI Number | 1417025453
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Entity Type | Individual
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Provider Name | TASRINA DOWLA DARA RD
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 550 OSBORNE RD NE
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City | FRIDLEY
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State | MN
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Zip | 55432-2718
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Country | US
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Telephone | 763-236-3168
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Fax |
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Provider Business Mailing Address
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Address Line | 16125 XYLITE ST NE
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City | HAM LAKE X
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State | MN
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Zip | 55304-5724
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Country | US
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Telephone | 763-502-6686
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2555
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License Number State | MN
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