MEDICARE: KRISTI KALINSKY RD, LD

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	133N00000X	Nutritionist	3980	MN
2	133V00000X	Registered Dietitian	3980	MN

General Provider Information

NPI Number	:	1841965050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI KALINSKY RD, LD

Provider Business Mailing Address
First Line	:	17741 69TH PL N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3003
Country	:	US
Telephone Number	:	651-247-4033
Fax Number	:

Provider Business Practice Location Address
First Line	:	9509 BLACKOAKS LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-1229
Country	:	US
Telephone Number	:	763-657-1730
Fax Number	:

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

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	09/23/2024

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