Healthcare Provider Details

I. General information

NPI: 1609022284
Provider Name (Legal Business Name): KRISTINE LEWIS RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINE SLABA

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 N MAYFIELD DR
CLARION PA
16214-6149
US

IV. Provider business mailing address

1145 N MAYFIELD DR
CLARION PA
16214-6149
US

V. Phone/Fax

Practice location:
  • Phone: 330-232-9463
  • Fax:
Mailing address:
  • Phone: 330-232-9463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDN004352
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: