Provider Demographics
NPI:1891158903
Name:MAAHS, MARLAINE GRACE (NTP)
Entity Type:Individual
Prefix:
First Name:MARLAINE
Middle Name:GRACE
Last Name:MAAHS
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 REIDMOND LN
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1647
Mailing Address - Country:US
Mailing Address - Phone:651-491-3488
Mailing Address - Fax:
Practice Address - Street 1:2400 REIDMOND LN
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-1647
Practice Address - Country:US
Practice Address - Phone:651-491-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002016132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager