Provider Demographics
NPI:1316121122
Name:KODESKI, KRISTEN LORI (RD)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:LORI
Last Name:KODESKI
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 1:374 INVERNESS PKWY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5810
Mailing Address - Country:US
Mailing Address - Phone:303-790-7777
Mailing Address - Fax:303-799-0602
Practice Address - Street 1:374 INVERNESS PKWY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5810
Practice Address - Country:US
Practice Address - Phone:303-790-7777
Practice Address - Fax:303-799-0602
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered