Provider Demographics
NPI:1376904664
Name:GERMINO, GRETA (RD, CDE, LDN)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:GERMINO
Suffix:
Gender:F
Credentials:RD, CDE, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 HILLANDALE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2659
Mailing Address - Country:US
Mailing Address - Phone:919-383-5437
Mailing Address - Fax:
Practice Address - Street 1:1821 HILLANDALE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2659
Practice Address - Country:US
Practice Address - Phone:919-383-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004515133V00000X
NC86021177133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
21700963OtherNCBDE