Provider Demographics
NPI:1831877885
Name:STINE, KATHRYN B (MNT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:B
Last Name:STINE
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 S ACOMA ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-1505
Mailing Address - Country:US
Mailing Address - Phone:720-971-8447
Mailing Address - Fax:
Practice Address - Street 1:2801 S ACOMA ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-1505
Practice Address - Country:US
Practice Address - Phone:720-971-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist