Provider Demographics
NPI:1093117897
Name:GREENLEE, MICHELLE SNODGRASS (RD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SNODGRASS
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7549 NICKLAUS CIR
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1685
Mailing Address - Country:US
Mailing Address - Phone:804-357-1959
Mailing Address - Fax:
Practice Address - Street 1:7549 NICKLAUS CIR
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-1685
Practice Address - Country:US
Practice Address - Phone:804-357-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA841551133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered