Healthcare Provider Details

I. General information

NPI: 1497448138
Provider Name (Legal Business Name): KRISTIN ANNE BEHRENDS BRODY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 E 5TH AVE STE 324
EUGENE OR
97401-2771
US

IV. Provider business mailing address

304 DARTMOOR DR
EUGENE OR
97401-5728
US

V. Phone/Fax

Practice location:
  • Phone: 541-556-5646
  • Fax: 440-556-5642
Mailing address:
  • Phone: 541-729-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: