Provider Demographics
NPI:1790395317
Name:HOLTZ, KRISTINA JEAN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JEAN
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:LANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0551
Mailing Address - Fax:
Practice Address - Street 1:1210 S CEDAR CREST BLVD STE 2700
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6239
Practice Address - Country:US
Practice Address - Phone:610-402-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86076743133V00000X
PADN006303133V00000X
MDDX5023133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered