Provider Demographics
NPI:1750561684
Name:YODER LATORTUE, KRISTA (RD, LDN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:YODER LATORTUE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1839 MANTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2922
Mailing Address - Country:US
Mailing Address - Phone:215-827-6701
Mailing Address - Fax:
Practice Address - Street 1:502 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1348
Practice Address - Country:US
Practice Address - Phone:610-825-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003782133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric