Provider Demographics
NPI:1467077974
Name:LOOS, KRISTA (RD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:LOOS
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 1:17571 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-9289
Mailing Address - Country:US
Mailing Address - Phone:815-590-7157
Mailing Address - Fax:
Practice Address - Street 1:17571 TIMBER DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-9289
Practice Address - Country:US
Practice Address - Phone:815-590-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered