Healthcare Provider Details

I. General information

NPI: 1104564228
Provider Name (Legal Business Name): KRISTIN KUFEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 05/27/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6513 E EXETER BLVD
SCOTTSDALE AZ
85251-3103
US

IV. Provider business mailing address

6513 E EXETER BLVD
SCOTTSDALE AZ
85251-3103
US

V. Phone/Fax

Practice location:
  • Phone: 602-980-8486
  • Fax:
Mailing address:
  • Phone: 602-980-8486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: