Provider Demographics
NPI:1235192121
Name:GREBENC, JENNIFER L (RDN LD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:GREBENC
Suffix:
Gender:F
Credentials:RDN LD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:BIEKSZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN LD
Mailing Address - Street 1:6284 FOXWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2113
Mailing Address - Country:US
Mailing Address - Phone:440-665-8853
Mailing Address - Fax:
Practice Address - Street 1:6284 FOXWOOD CT
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2113
Practice Address - Country:US
Practice Address - Phone:440-665-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 3060133V00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4303828Medicaid