Provider Demographics
NPI:1487770145
Name:KRAUS, KATHY ELLEN (RD)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ELLEN
Last Name:KRAUS
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 1:82 AKBAR RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1402
Mailing Address - Country:US
Mailing Address - Phone:203-912-9449
Mailing Address - Fax:203-324-1190
Practice Address - Street 1:82 AKBAR RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1402
Practice Address - Country:US
Practice Address - Phone:203-912-9449
Practice Address - Fax:203-324-1190
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000222133V00000X
NY0063111133N00000X
NY006311133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2168469OtherOXFORD
CT270000222CT01OtherBC/BS
CT5455578OtherAETNA