Provider Demographics
NPI:1053081430
Name:DRAGAN, KRISHNA D (RDN)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:D
Last Name:DRAGAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6156 SHIPSLANDING AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3721
Mailing Address - Country:US
Mailing Address - Phone:330-412-1394
Mailing Address - Fax:
Practice Address - Street 1:6156 SHIPSLANDING AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3721
Practice Address - Country:US
Practice Address - Phone:330-412-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLD.8173OtherOHIO MEDICAL BOARD
86066888OtherCOMMISION OF DIETETIC REGISTRATION