Provider Demographics
NPI:1063604783
Name:O'BRIEN-NIMENS, CYNTHIA A (RD)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:A
Last Name:O'BRIEN-NIMENS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 44TH AVE S
Mailing Address - Street 2:SUITE 112D
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3434
Mailing Address - Country:US
Mailing Address - Phone:701-775-5800
Mailing Address - Fax:701-775-5200
Practice Address - Street 1:1451 44TH AVE S
Practice Address - Street 2:SUITE 112D
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3434
Practice Address - Country:US
Practice Address - Phone:701-775-5800
Practice Address - Fax:701-775-5200
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND334133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered