Active NPI
Abby Casanova, RD, LD
- Registered Dietitian
- Eden Prairie, MN
National Provider Identifier
1770340663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 4923
- Practice address
- 6385 Old Shady Oak Rd
Eden Prairie, MN 55344-3299 - Phone
- (612) 425-1529
- NPI assigned
- Mar 6, 2024
- Last updated
- Mar 6, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 4923 | MN | Primary |
Addresses
Primary practice location
6385 Old Shady Oak Rd
Eden Prairie, MN 55344-3299
Mailing address
6323 Deerwood LN
Lino Lakes, MN 55014-5467
Phone (612) 816-6966
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4923 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709683200000",
"number": "1770340663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6323 DEERWOOD LN",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550145467",
"telephone_number": "612-816-6966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6385 OLD SHADY OAK RD",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443299",
"telephone_number": "612-425-1529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASANOVA",
"first_name": "ABBY",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-06",
"last_updated": "2024-03-06",
"certification_date": "2024-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "4923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.