Provider Demographics
NPI:1164843504
Name:DOUGLAS, CHRISTINE ELLEN (RD, LMNT, LD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELLEN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:RD, LMNT, LD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELLEN
Other - Last Name:HRABAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:505 S. BURG STREET
Mailing Address - Street 2:KIMBALL HEALTH SERVICES AT
Mailing Address - City:KIMBALL
Mailing Address - State:NE
Mailing Address - Zip Code:69145
Mailing Address - Country:US
Mailing Address - Phone:308-235-1966
Mailing Address - Fax:308-235-1957
Practice Address - Street 1:505 S. BURG STREET
Practice Address - Street 2:KIMBALL HEALTH SERVICES AT
Practice Address - City:KIMBALL
Practice Address - State:NE
Practice Address - Zip Code:69145
Practice Address - Country:US
Practice Address - Phone:308-235-1966
Practice Address - Fax:308-235-1957
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE458133V00000X
WY022133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered