Provider Demographics
NPI:1366247108
Name:SMITH, CHRISTINE JEAN (RD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:JEAN
Other - Last Name:KRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:592 PERTHSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4741
Mailing Address - Country:US
Mailing Address - Phone:908-763-6440
Mailing Address - Fax:
Practice Address - Street 1:592 PERTHSHIRE CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4741
Practice Address - Country:US
Practice Address - Phone:908-763-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1025495133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered