Provider Demographics
NPI:1629831748
Name:WISENOR, KAYTLIN (RDN)
Entity Type:Individual
Prefix:
First Name:KAYTLIN
Middle Name:
Last Name:WISENOR
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 SYRACUSE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2015
Mailing Address - Country:US
Mailing Address - Phone:303-489-2865
Mailing Address - Fax:
Practice Address - Street 1:1680 SYRACUSE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2015
Practice Address - Country:US
Practice Address - Phone:303-489-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86343945133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered