Provider Demographics
NPI:1962126938
Name:URENA, KRISTIN L
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:URENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 VALMONT RD APT 302D
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2998
Mailing Address - Country:US
Mailing Address - Phone:973-897-7661
Mailing Address - Fax:
Practice Address - Street 1:2707 VALMONT RD APT 302D
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2998
Practice Address - Country:US
Practice Address - Phone:973-897-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86085280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered