Provider Demographics
NPI:1922481936
Name:KOMAN, KRISTEN A (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:KOMAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:4200 STATE RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6017
Mailing Address - Country:US
Mailing Address - Phone:440-998-7515
Mailing Address - Fax:440-998-0973
Practice Address - Street 1:4200 STATE RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6017
Practice Address - Country:US
Practice Address - Phone:440-998-7515
Practice Address - Fax:440-998-0973
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.4030133V00000X
PADN002378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered