Provider Demographics
NPI:1760604607
Name:GUIDARELLI, KAY M (RD, LD)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:M
Last Name:GUIDARELLI
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7136 MUIRFIELD LANE
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346
Mailing Address - Country:US
Mailing Address - Phone:952-937-8607
Mailing Address - Fax:
Practice Address - Street 1:5009 EXCELSIOR BOULEVARD
Practice Address - Street 2:SUITE 112
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-937-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1618133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered