Provider Demographics
NPI:1922034651
Name:WEMPEN, KRISTI LYN (RD LD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYN
Last Name:WEMPEN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:LYN
Other - Last Name:KRENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:406 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56024-8612
Mailing Address - Country:US
Mailing Address - Phone:507-430-0827
Mailing Address - Fax:
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4752
Practice Address - Country:US
Practice Address - Phone:507-385-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2558133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered