Provider Demographics
NPI:1821717588
Name:RICH, KRISTINA (NBC-HWC, CPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:NBC-HWC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 VERNON ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3641
Mailing Address - Country:US
Mailing Address - Phone:616-901-0330
Mailing Address - Fax:
Practice Address - Street 1:435 IONIA AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5161
Practice Address - Country:US
Practice Address - Phone:616-901-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI879253694171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach