Provider Demographics
NPI:1104097955
Name:MASON, KRISTI (RD, LD)
Entity type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-6272
Mailing Address - Fax:419-383-3112
Practice Address - Street 1:1125 HOSPITAL DR.
Practice Address - Street 2:HEALTH SCIENCE CAMPUS MAIL STOP 1062
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2598
Practice Address - Country:US
Practice Address - Phone:419-383-4585
Practice Address - Fax:419-383-3112
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 5063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
73675Medicare UPIN