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General NPI Number Information
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NPI Number | 1497592968
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Entity Type | Organization
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Legal Business Name | CRUA NUTRITION LLC
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Dates
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Enumeration Date | 07/11/2024
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 74 FAUNCE CORNER RD STE 630
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City | DARTMOUTH
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State | MA
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Zip | 02747-1209
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Country | US
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Telephone | 774-377-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 14 BENNETT RD
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City | ROCHESTER
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State | MA
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Zip | 02770-1832
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Country | US
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Telephone | 508-254-5639
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN/OWNER
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Name | KATLYNN KISLA
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Credential | MS, RDN, LDN
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Telephone | 508-254-5639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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