Provider Demographics
NPI:1669978672
Name:HUSLEBUS, KAYLA (RDN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:HUSLEBUS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 SQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-3169
Mailing Address - Country:US
Mailing Address - Phone:952-261-9843
Mailing Address - Fax:
Practice Address - Street 1:9600 SQUIRE LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-3169
Practice Address - Country:US
Practice Address - Phone:952-261-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86054815133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered