Provider Demographics
NPI:1215446968
Name:STRUKOFF, KRISTA BETHANY (MS, RDN, LDN)
Entity type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:BETHANY
Last Name:STRUKOFF
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2258
Mailing Address - Country:US
Mailing Address - Phone:309-256-4509
Mailing Address - Fax:
Practice Address - Street 1:443 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2258
Practice Address - Country:US
Practice Address - Phone:309-256-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86045899133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered