Provider Demographics
NPI:1255503207
Name:SCHRECK, KRISTEN PUFAHL (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:PUFAHL
Last Name:SCHRECK
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 LOVELL RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1301
Mailing Address - Country:US
Mailing Address - Phone:781-462-1722
Mailing Address - Fax:
Practice Address - Street 1:67 LOVELL RD
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-1301
Practice Address - Country:US
Practice Address - Phone:781-462-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2669133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered