Provider Demographics
NPI:1962148007
Name:KOVAL, CHRISTINE NICOLE (RDN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:KOVAL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RIVER BEND RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3929
Mailing Address - Country:US
Mailing Address - Phone:203-415-6484
Mailing Address - Fax:
Practice Address - Street 1:35 JEM WOODS RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1594
Practice Address - Country:US
Practice Address - Phone:203-415-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1600133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered