Provider Demographics
NPI:1083847743
Name:ZVOCH, KRISTA KORODY (RD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:KORODY
Last Name:ZVOCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-0205
Mailing Address - Country:US
Mailing Address - Phone:810-714-1105
Mailing Address - Fax:810-714-1105
Practice Address - Street 1:10054 SHADYBROOK LN
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8317
Practice Address - Country:US
Practice Address - Phone:810-714-1105
Practice Address - Fax:810-714-1105
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered