Provider Demographics
NPI:1891704722
Name:UPTON, KATHLEEN G (RD, LMNT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:G
Last Name:UPTON
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:G
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:339 N 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2407
Mailing Address - Country:US
Mailing Address - Phone:402-991-3130
Mailing Address - Fax:
Practice Address - Street 1:339 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2407
Practice Address - Country:US
Practice Address - Phone:402-991-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE697133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE276854Medicare ID - Type UnspecifiedPROVIDER NUMBER