Provider Demographics
NPI:1497063309
Name:NEBERGALL, KRISTEN KAY (RD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KAY
Last Name:NEBERGALL
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 1:1512 WHITTERS WAY NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-1543
Mailing Address - Country:US
Mailing Address - Phone:319-899-3644
Mailing Address - Fax:
Practice Address - Street 1:1512 WHITTERS WAY NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-1543
Practice Address - Country:US
Practice Address - Phone:319-899-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered