Provider Demographics
NPI:1154905800
Name:MINIHAN, KATHLEEN ANNA (RD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNA
Last Name:MINIHAN
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 1:16 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2772
Mailing Address - Country:US
Mailing Address - Phone:508-901-9583
Mailing Address - Fax:
Practice Address - Street 1:16 SOMERSET LN
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2772
Practice Address - Country:US
Practice Address - Phone:508-517-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered