Individual
ANNA HERONIMUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1500 CENTRAL PARK COMMONS DR, EAGAN, MN 55121-8702
(361) 405-3664
Mailing address
1500 CENTRAL PARK COMMONS DR, EAGAN, MN 55121-8702
(651) 405-3660
(651) 405-3691
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
0515
SD
133V00000X
Registered Dietitian
Primary
3983
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144699000
—
SD
Enumeration date
09/22/2015
Last updated
02/25/2019
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