Provider Demographics
NPI:1811397185
Name:HUNTSMAN, KRISTIN (RDN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HUNTSMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 TRANSVERSE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-8008
Mailing Address - Country:US
Mailing Address - Phone:419-383-4302
Mailing Address - Fax:419-383-2852
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-4302
Practice Address - Fax:419-383-2852
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2024-07-03
Deactivation Date:2019-01-31
Deactivation Code:
Reactivation Date:2023-08-16
Provider Licenses
StateLicense IDTaxonomies
OH3155133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered