Provider Demographics
NPI:1225378813
Name:RENNER, KRISTIN D (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:D
Last Name:RENNER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 STRETCHS WAY
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4501
Mailing Address - Country:US
Mailing Address - Phone:802-238-4174
Mailing Address - Fax:
Practice Address - Street 1:174 RIVER ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3827
Practice Address - Country:US
Practice Address - Phone:802-505-0597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0093155175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1021967Medicaid