Provider Demographics
NPI:1760802797
Name:MURACHVER, KIMBERLY GREENE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GREENE
Last Name:MURACHVER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:111 W 8TH ST APT H
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2566
Mailing Address - Country:US
Mailing Address - Phone:603-494-5234
Mailing Address - Fax:
Practice Address - Street 1:525 MASSACHUSETTS AVE STE 101C
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:617-356-7037
Practice Address - Fax:617-300-8945
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3574133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered