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General NPI Number Information
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NPI Number | 1811228604
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Entity Type | Individual
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Provider Name | KIRSTEN LYNN MOLLDREM R.D.
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Gender | Female
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 6835 AUSTIN CENTER BLVD
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City | AUSTIN
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State | TX
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Zip | 78731-3166
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Country | US
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Telephone | 512-483-9595
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Fax |
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Provider Business Mailing Address
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Address Line | 6210 E HIGHWAY 290
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City | AUSTIN
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State | TX
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Zip | 78723-1142
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 912765
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License Number State | WI
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