Provider Demographics
NPI:1023203718
Name:DEFRANG, RENEE ANN (RD CDE)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ANN
Last Name:DEFRANG
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:ANN
Other - Last Name:GOULETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 S NELSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2138
Mailing Address - Country:US
Mailing Address - Phone:616-754-6185
Mailing Address - Fax:616-754-6407
Practice Address - Street 1:407 S NELSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2138
Practice Address - Country:US
Practice Address - Phone:616-754-6185
Practice Address - Fax:616-754-6407
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI886452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION62630Medicare PIN