Provider Demographics
NPI:1114460698
Name:MARTINEZ, DRIENIE GROBBELAAR (MS, RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DRIENIE
Middle Name:GROBBELAAR
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NW MAYNARD RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8706
Mailing Address - Country:US
Mailing Address - Phone:919-238-4554
Mailing Address - Fax:
Practice Address - Street 1:1100 NW MAYNARD RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8706
Practice Address - Country:US
Practice Address - Phone:919-238-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004929133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1659760338OtherANNE TILL CONSULTING LLC ORGANIZATIONAL NPI