Individual
KRISTIN MARIE BULKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D, L.D.N
Contact information
Practice address
15728 S ROUTE 59, PLAINFIELD, IL 60544-2693
(815) 436-8831
(815) 436-6863
Mailing address
15728 S ROUTE 59, PLAINFIELD, IL 60544-2693
(815) 436-8831
(815) 436-6863
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
164004687
IL
133V00000X
Registered Dietitian
Primary
164004687
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164004687
—
IL
01
—
P00186793
RAILROAD MEDICARE PTAN
IL
Enumeration date
08/15/2007
Last updated
05/20/2008
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