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NPI Code Detail

MEDICARE: MRS. KRISTINA K. LAVIS R.D.

MEDICARE: MRS. KRISTINA K. LAVIS R.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1730261249
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTINA K. LAVIS R.D.
Provider Business Mailing Address
First Line : 1515 PARK AVE
Second Line :
City : COLUMBUS
State : WI
Zip : 53925-2402
Country : US
Telephone Number : 920-623-2200
Fax Number : 920-623-1441
Provider Business Practice Location Address
First Line : 1515 PARK AVE
Second Line :
City : COLUMBUS
State : WI
Zip : 53925-2402
Country : US
Telephone Number : 920-623-2200
Fax Number : 920-623-1441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 07/08/2007

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