Provider Demographics
NPI:1902145337
Name:LINDSTROM, KRISTEN ELISE (RD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELISE
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5361 BYRAM AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-2423
Mailing Address - Country:US
Mailing Address - Phone:317-340-0822
Mailing Address - Fax:317-259-7463
Practice Address - Street 1:5361 BYRAM AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-2423
Practice Address - Country:US
Practice Address - Phone:317-340-0822
Practice Address - Fax:317-259-7463
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1001929133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered