Provider Demographics
NPI:1336533157
Name:WEBER, KRISTIN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1900 HAMILTON ST
Mailing Address - Street 2:UNIT 302
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3889
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 HAMILTON ST
Practice Address - Street 2:UNIT 302
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3889
Practice Address - Country:US
Practice Address - Phone:215-601-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered