Provider Demographics
NPI:1023466364
Name:KISSANE, KATIE (RD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KISSANE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:KISSANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:33652 COUNTY ROAD 21
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3205
Mailing Address - Country:US
Mailing Address - Phone:303-818-5363
Mailing Address - Fax:
Practice Address - Street 1:33652 COUNTY ROAD 21
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3205
Practice Address - Country:US
Practice Address - Phone:303-818-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1075934133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered