Provider Demographics
NPI:1497496939
Name:PFANNMULLER, KIRSTEN (MS, RD, LN)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:PFANNMULLER
Suffix:
Gender:F
Credentials:MS, RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 S WILLSON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5296
Mailing Address - Country:US
Mailing Address - Phone:208-631-8965
Mailing Address - Fax:
Practice Address - Street 1:1106 S WILLSON AVE APT 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5296
Practice Address - Country:US
Practice Address - Phone:208-631-8965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT108818133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered