Provider Demographics
NPI:1407276140
Name:LAFOE, KRISTINA (RD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:LAFOE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15308 136TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9241
Mailing Address - Country:US
Mailing Address - Phone:253-227-8284
Mailing Address - Fax:206-350-2612
Practice Address - Street 1:3806 9TH ST SW
Practice Address - Street 2:SUITE C
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3687
Practice Address - Country:US
Practice Address - Phone:253-227-8284
Practice Address - Fax:206-350-2612
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60257940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered