Basic Information
| Provider Information | |||||||||
| NPI: | 1831430164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REZABEK | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | MS, RD, CD, CDE | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDREWS | ||||||||
| OtherFirstName: | KRISTEN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MS, RD, CD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE DEPT 358 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986838004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607291462 | ||||||||
| FaxNumber: | 3607293104 | ||||||||
| Practice Location | |||||||||
| Address1: | 1117 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | FRIDAY HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982509782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603782141 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2013 | ||||||||
| LastUpdateDate: | 11/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI00001380 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.