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General NPI Number Information
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NPI Number | 1487131991
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Entity Type | Organization
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Legal Business Name | SALEM DIETETICS, LLC
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 9325 UPLAND LN N STE 320
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4451
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Country | US
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Telephone | 917-330-8441
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Fax |
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Provider Business Mailing Address
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Address Line | 9325 UPLAND LN N STE 320
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4451
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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 | CEO
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Name | DOHA SALEM
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Credential | MS, RD, CDE
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Telephone | 917-330-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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