Provider Demographics
NPI:1992000475
Name:ROSS, KRISTIN (RD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G3200 BEECHER RD
Mailing Address - Street 2:DIABETES EDUCATION
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3651
Mailing Address - Country:US
Mailing Address - Phone:810-342-4110
Mailing Address - Fax:810-342-4428
Practice Address - Street 1:G3200 BEECHER RD
Practice Address - Street 2:DIABETES EDUCATION
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3651
Practice Address - Country:US
Practice Address - Phone:810-342-4110
Practice Address - Fax:810-342-4428
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI995922133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered