Healthcare Provider Details

I. General information

NPI: 1538179148
Provider Name (Legal Business Name): KRISTINE BAHR MNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WASHINGTON ST. SUITE 401
BROOKLINE MA
02445
US

IV. Provider business mailing address

320 WASHINGTON ST. SUITE 401
BROOKLINE MA
02445
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-9838
  • Fax:
Mailing address:
  • Phone: 617-360-1929
  • Fax: 413-332-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1707
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: