Provider Demographics
NPI:1336836642
Name:STEVENS, KRISTIN (MSCN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 WAYZATA CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7953
Mailing Address - Country:US
Mailing Address - Phone:503-680-3645
Mailing Address - Fax:
Practice Address - Street 1:6227 WAYZATA CT
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7953
Practice Address - Country:US
Practice Address - Phone:503-680-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist