Provider Demographics
NPI:1841673449
Name:GREENE, KRISTINA (RD,MS, CDE)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:RD,MS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8126
Mailing Address - Country:US
Mailing Address - Phone:219-738-5802
Mailing Address - Fax:
Practice Address - Street 1:303 E 89TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8126
Practice Address - Country:US
Practice Address - Phone:219-738-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001889A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered