Healthcare Provider Details

I. General information

NPI: 1053787671
Provider Name (Legal Business Name): KRISTEN KOWALSKE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 BRUCEVILLE RD
SACRAMENTO CA
95823-2329
US

IV. Provider business mailing address

1724 GUILDFORD WAY
PLUMAS LAKE CA
95961-9146
US

V. Phone/Fax

Practice location:
  • Phone: 916-288-0401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number978257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: