Provider Demographics
NPI:1124784525
Name:LORENZ, KRISTEN (RD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LORENZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 REEDS LAKE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2053
Mailing Address - Country:US
Mailing Address - Phone:616-443-7775
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW FL 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-579-0795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000495133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
974290OtherCOMMISSION DIETETIC REGISTRATION (CDR)
DCDI100000495OtherDC DOH LICENSE