Healthcare Provider Details

I. General information

NPI: 1962126938
Provider Name (Legal Business Name): KRISTIN L URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 06/16/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 VALMONT RD APT 302D
BOULDER CO
80304-2998
US

IV. Provider business mailing address

2707 VALMONT RD APT 302D
BOULDER CO
80304-2998
US

V. Phone/Fax

Practice location:
  • Phone: 973-897-7661
  • Fax:
Mailing address:
  • Phone: 973-897-7661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86085280
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: