Provider Demographics
NPI:1770340663
Name:CASANOVA, ABBY (RD, LD)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 DEERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-5467
Mailing Address - Country:US
Mailing Address - Phone:612-816-6966
Mailing Address - Fax:
Practice Address - Street 1:6385 OLD SHADY OAK RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3299
Practice Address - Country:US
Practice Address - Phone:612-425-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4923133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered