Individual
DOHA SALEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4000 CENTRAL AVE NE, COLUMBIA HEIGHTS, MN 55421-2968
(763) 782-8183
Mailing address
18680 97TH PL N # EN, MAPLE GROVE, MN 55311-1366
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86046832
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-3505719
—
MN
Enumeration date
04/11/2018
Last updated
10/30/2019
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