Provider Demographics
NPI:1467531871
Name:HULTIN, REGINA (RD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:HULTIN
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 1:1930 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4759
Mailing Address - Country:US
Mailing Address - Phone:406-457-8958
Mailing Address - Fax:406-457-8990
Practice Address - Street 1:1930 9TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4759
Practice Address - Country:US
Practice Address - Phone:406-457-8958
Practice Address - Fax:406-457-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000298718OtherBCBS PIN
MT0280874OtherMDCD PIN