Healthcare Provider Details

I. General information

NPI: 1306287958
Provider Name (Legal Business Name): WENDY KRITENBRINK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 MADISON AVE
COUNCIL BLUFFS IA
51503-5249
US

IV. Provider business mailing address

1745 MADISON AVE
COUNCIL BLUFFS IA
51503-5249
US

V. Phone/Fax

Practice location:
  • Phone: 712-322-9260
  • Fax: 712-329-0263
Mailing address:
  • Phone: 712-322-9260
  • Fax: 712-329-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01422
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: