MEDICARE: KATHRYN MACIAS RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2573	MN

General Provider Information

NPI Number	:	1639018559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MACIAS RDN

Provider Business Mailing Address
First Line	:	7557 101ST ST N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55110-1306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7557 101ST ST N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55110-1306
Country	:	US
Telephone Number	:	651-334-3552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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