Provider Demographics
NPI:1730980483
Name:KRISTINE BERUBE WELLNESS
Entity type:Organization
Organization Name:KRISTINE BERUBE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERUBE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:978-340-8834
Mailing Address - Street 1:3 OAKDALE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-5104
Mailing Address - Country:US
Mailing Address - Phone:978-340-8834
Mailing Address - Fax:
Practice Address - Street 1:3 OAKDALE ST APT 2
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-5104
Practice Address - Country:US
Practice Address - Phone:978-340-8834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty