Provider Demographics
NPI:1225611213
Name:WEAVER, KRISTEN (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 UPPER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN LANE
Mailing Address - State:PA
Mailing Address - Zip Code:18054-9418
Mailing Address - Country:US
Mailing Address - Phone:267-337-3710
Mailing Address - Fax:
Practice Address - Street 1:403 W RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-3451
Practice Address - Country:US
Practice Address - Phone:610-454-7332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006412133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered