Healthcare Provider Details

I. General information

NPI: 1154616365
Provider Name (Legal Business Name): KRISTY DEL CORO MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WALNUT HILL RD
NORTH YARMOUTH ME
04097-6507
US

IV. Provider business mailing address

165 WALNUT HILL RD
NORTH YARMOUTH ME
04097-6507
US

V. Phone/Fax

Practice location:
  • Phone: 410-430-0730
  • Fax:
Mailing address:
  • Phone: 410-430-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number48 006579
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number00978064
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: