Individual
MRS. SANDRA RAE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
10006 MAPLE CIR, BLOOMINGTON, MN 55431-2870
(952) 884-5489
Mailing address
10006 MAPLE CIR, BLOOMINGTON, MN 55431-2870
(952) 884-5489
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2086
MN
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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