Healthcare Provider Details

I. General information

NPI: 1225339427
Provider Name (Legal Business Name): KRISTEN S PUTT RD/LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N. 6TH STREET
READING PA
19603-0316
US

IV. Provider business mailing address

2500 BERNVILLE ROAD (ROUTE 183) ST. JOSEPH MEDICAL CENTER
READING PA
19605
US

V. Phone/Fax

Practice location:
  • Phone: 610-378-2100
  • Fax: 610-208-4775
Mailing address:
  • Phone: 610-378-2487
  • Fax: 610-378-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: