Provider Demographics
NPI:1043403603
Name:KRESSER, ALYSON L (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:L
Last Name:KRESSER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:ALYSON
Other - Middle Name:L
Other - Last Name:KRESSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:92 AMDS/SGPZ
Mailing Address - Street 2:701 HOSPITAL LOOP
Mailing Address - City:FAIRCHILD AIR FORCE BASE
Mailing Address - State:WA
Mailing Address - Zip Code:99011
Mailing Address - Country:US
Mailing Address - Phone:509-247-5590
Mailing Address - Fax:509-247-2314
Practice Address - Street 1:92 AMDS/SGPZ
Practice Address - Street 2:701 HOSPITAL LOOP
Practice Address - City:FAIRCHILD AIR FORCE BASE
Practice Address - State:WA
Practice Address - Zip Code:99011
Practice Address - Country:US
Practice Address - Phone:509-247-5590
Practice Address - Fax:509-247-2314
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA925144133V00000X
WADI 60018751133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist