Provider Demographics
NPI:1518177112
Name:KARDELL, MARY LYNN (RD, LMNT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:KARDELL
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 S 184TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2793
Mailing Address - Country:US
Mailing Address - Phone:402-614-9912
Mailing Address - Fax:866-287-8592
Practice Address - Street 1:7701 PACIFIC ST.
Practice Address - Street 2:SUITE #10
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:402-390-6007
Practice Address - Fax:866-287-8592
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE726190133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered