Provider Demographics
NPI:1104114321
Name:EDDY-THORNE, KRISTAN ELLEN (LDN)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:ELLEN
Last Name:EDDY-THORNE
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:KRISTAN
Other - Middle Name:ELLEN
Other - Last Name:EDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:745 FIR SPRING DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-2914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:745 FIR SPRING DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2914
Practice Address - Country:US
Practice Address - Phone:717-372-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered