Provider Demographics
NPI:1750096921
Name:ALVIS, KRISTEN (BCHHP, CNC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ALVIS
Suffix:
Gender:F
Credentials:BCHHP, CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82622
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0622
Mailing Address - Country:US
Mailing Address - Phone:503-893-4943
Mailing Address - Fax:
Practice Address - Street 1:15397 SE SHALE DR
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97089-8419
Practice Address - Country:US
Practice Address - Phone:503-893-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist