Individual
MRS. LANA KALLEEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
2800 CLEVELAND AVE N, ROSEVILLE, MN 55113-1126
(651) 642-1825
Mailing address
2965 MANSON ST, ROSEVILLE, MN 55113-1029
(612) 289-0644
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
3281
MN
Other
Enumeration date
11/18/2013
Last updated
04/26/2018
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