Provider Demographics
NPI:1154085348
Name:LAGREE, KRISTINE (RD, LD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:LAGREE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OLD SUMMER HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3227
Mailing Address - Country:US
Mailing Address - Phone:812-296-0653
Mailing Address - Fax:
Practice Address - Street 1:25 OLD SUMMER HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3227
Practice Address - Country:US
Practice Address - Phone:812-296-0653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002785A133V00000X
GALD005893133V00000X
SC1323133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered