Provider Demographics
NPI:1952493314
Name:CULLEN, KRISTEN (RD, CDN, CDE)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CULLEN
Suffix:
Gender:F
Credentials:RD, CDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6237
Mailing Address - Country:US
Mailing Address - Phone:845-223-6218
Mailing Address - Fax:
Practice Address - Street 1:4 WILLOW DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6237
Practice Address - Country:US
Practice Address - Phone:845-223-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY812395133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered