Provider Demographics
NPI:1205028693
Name:GRUNEISEN, KRISTIN MARIE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MARIE
Last Name:GRUNEISEN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MANGROVE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2633
Mailing Address - Country:US
Mailing Address - Phone:530-898-6476
Mailing Address - Fax:530-345-0668
Practice Address - Street 1:1311 MANGROVE AVE STE B
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2633
Practice Address - Country:US
Practice Address - Phone:530-898-6476
Practice Address - Fax:530-345-0668
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered