Provider Demographics
NPI:1912776535
Name:RISSER, KATHRYN (RD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:RISSER
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 1:2734 ROOKE AVE APT A3
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1395
Mailing Address - Country:US
Mailing Address - Phone:619-415-1102
Mailing Address - Fax:
Practice Address - Street 1:2734 ROOKE AVE APT A3
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1395
Practice Address - Country:US
Practice Address - Phone:619-415-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86113080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered