Provider Demographics
NPI:1033371786
Name:BERTRAND, CRYSTAL ANN (RD,LD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ANN
Other - Last Name:GIERSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2090 S OHIO ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6702
Mailing Address - Country:US
Mailing Address - Phone:785-825-8221
Mailing Address - Fax:785-452-7530
Practice Address - Street 1:2090 S OHIO ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-6702
Practice Address - Country:US
Practice Address - Phone:785-825-8221
Practice Address - Fax:785-452-7530
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1262133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201069820AMedicaid
KS201069820AMedicaid