Individual
LYNN M KITSLAAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4700
(920) 430-4747
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1399-29
WI
133VN1006X
Metabolic Nutrition Registered Dietitian
1399-29
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20110340
NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS
WI
01
—
850912
COMMISSION ON DIETETIC REGISTRATION
WI
Enumeration date
12/07/2005
Last updated
08/21/2019
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