Provider Demographics
NPI:1689961641
Name:MARQUEZ, KIRSTEN (RD, LD/N, CNSC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:RD, LD/N, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 25TH CT
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-9332
Mailing Address - Country:US
Mailing Address - Phone:908-625-8067
Mailing Address - Fax:
Practice Address - Street 1:2513 25TH CT
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-9332
Practice Address - Country:US
Practice Address - Phone:908-625-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3796133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered