Provider Demographics
NPI:1811676232
Name:RUDIGER, CRYSTAL RENEE' (MS, RDN)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RENEE'
Last Name:RUDIGER
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GLASS SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-8625
Mailing Address - Country:US
Mailing Address - Phone:817-296-0267
Mailing Address - Fax:
Practice Address - Street 1:1265 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3639
Practice Address - Country:US
Practice Address - Phone:615-794-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX898367133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered