Provider Demographics
NPI:1609478668
Name:CRAVEN, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 SE CORPORATE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-7405
Mailing Address - Country:US
Mailing Address - Phone:866-716-3257
Mailing Address - Fax:515-266-6120
Practice Address - Street 1:3210 SE CORPORATE WOODS DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-7405
Practice Address - Country:US
Practice Address - Phone:866-716-3257
Practice Address - Fax:515-266-6120
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86131468133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered