Provider Demographics
NPI:1548538689
Name:WILLARD, KRISTIN (RD)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:WILLARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:WEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1940 BIDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-9645
Mailing Address - Country:US
Mailing Address - Phone:530-570-2361
Mailing Address - Fax:
Practice Address - Street 1:1940 BIDWELL AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-9645
Practice Address - Country:US
Practice Address - Phone:530-570-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00999001133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered