Healthcare Provider Details

I. General information

NPI: 1497153829
Provider Name (Legal Business Name): KRISTEN MSHAR R.D., L.D.N., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S CLAY ST STE 210
HINSDALE IL
60521-3257
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-8890
  • Fax: 630-789-8892
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164001052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: