Provider Demographics
NPI:1285337394
Name:ALFONSI, KRISTEN BEESE (RD)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:BEESE
Last Name:ALFONSI
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 1:643 N RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1733
Mailing Address - Country:US
Mailing Address - Phone:708-769-9551
Mailing Address - Fax:
Practice Address - Street 1:643 N RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1733
Practice Address - Country:US
Practice Address - Phone:708-769-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL817599133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered