Provider Demographics
NPI:1871907717
Name:DELLE, KRISTAN (RD, LDN, CLC)
Entity type:Individual
Prefix:MS
First Name:KRISTAN
Middle Name:
Last Name:DELLE
Suffix:
Gender:F
Credentials:RD, LDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9531 CLARK ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3901
Mailing Address - Country:US
Mailing Address - Phone:267-975-9033
Mailing Address - Fax:
Practice Address - Street 1:3103 HULMEVILLE RD
Practice Address - Street 2:STE. 106
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4381
Practice Address - Country:US
Practice Address - Phone:267-975-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005350133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered