Healthcare Provider Details

I. General information

NPI: 1750465746
Provider Name (Legal Business Name): KRISTEN BOLTON MS, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST UHC 5TH FLOOR
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

392 BROWNS TRACE
JERICHO VT
05465-9785
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-0239
  • Fax: 802-847-2226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number074-0000159
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: