Provider Demographics
NPI:1033279781
Name:CAMPBELL, MARIANNE GRONSTAL (RD)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:GRONSTAL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 FRANK ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4551
Mailing Address - Country:US
Mailing Address - Phone:712-322-7605
Mailing Address - Fax:
Practice Address - Street 1:5084 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2323
Practice Address - Country:US
Practice Address - Phone:402-451-7745
Practice Address - Fax:402-451-8090
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE334133VN1005X
IA00025133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal