Provider Demographics
NPI:1477205169
Name:GREITZER, ALEXANDRA ELINORE (MS, RD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELINORE
Last Name:GREITZER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 FIELD HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-9599
Mailing Address - Country:US
Mailing Address - Phone:719-333-7704
Mailing Address - Fax:
Practice Address - Street 1:2168 FIELD HOUSE DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-9599
Practice Address - Country:US
Practice Address - Phone:719-333-7704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86072959133V00000X
133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered