Provider Demographics
NPI:1013376268
Name:GREENE, JANALEE J (MDA, RD, CD)
Entity Type:Individual
Prefix:
First Name:JANALEE
Middle Name:J
Last Name:GREENE
Suffix:
Gender:F
Credentials:MDA, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:RIVER HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5645
Mailing Address - Country:US
Mailing Address - Phone:435-770-7139
Mailing Address - Fax:
Practice Address - Street 1:1034 RSI DR
Practice Address - Street 2:UNIT 100, SUITE E
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-2203
Practice Address - Country:US
Practice Address - Phone:435-770-7139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7394998-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered