MEDICARE: KRISTINA HALLBERG RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1002071	AZ

General Provider Information

NPI Number	:	1144709437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA HALLBERG RDN

Provider Business Mailing Address
First Line	:	8200 E LIPPIZAN TRL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-1369
Country	:	US
Telephone Number	:	480-707-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-6059
Country	:	US
Telephone Number	:	480-707-2081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/08/2018

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Directions to “ KRISTINA HALLBERG RDN” Practice Location

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