Healthcare Provider Details

I. General information

NPI: 1124639448
Provider Name (Legal Business Name): KRISTIN REPELLA RD, DTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STATE ST
FRAMINGHAM MA
01702-2499
US

IV. Provider business mailing address

100 STATE ST
FRAMINGHAM MA
01702-2499
US

V. Phone/Fax

Practice location:
  • Phone: 508-620-1220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: