Provider Demographics
NPI:1215574314
Name:GREASON, JODY (MS)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:GREASON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 GODFREY LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1301
Mailing Address - Country:US
Mailing Address - Phone:757-593-5595
Mailing Address - Fax:
Practice Address - Street 1:1621 GODFREY LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1301
Practice Address - Country:US
Practice Address - Phone:757-593-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-08
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist