Provider Demographics
NPI:1518177112
Name:KARDELL, MARY LYNN (RD, LMNT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:KARDELL
Suffix:
Gender:
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21919 PIERCE CIR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-1709
Mailing Address - Country:US
Mailing Address - Phone:402-630-7415
Mailing Address - Fax:844-755-6400
Practice Address - Street 1:21919 PIERCE CIR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-1709
Practice Address - Country:US
Practice Address - Phone:402-630-7415
Practice Address - Fax:844-755-6400
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE726190133V00000X
NE742133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered