Provider Demographics
NPI:1508559980
Name:RENFREE, MEGAN JENNA (RD, CPT, BCS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JENNA
Last Name:RENFREE
Suffix:
Gender:F
Credentials:RD, CPT, BCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WESTOVER LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1153
Mailing Address - Country:US
Mailing Address - Phone:312-208-2775
Mailing Address - Fax:
Practice Address - Street 1:32 WESTOVER LN
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-1153
Practice Address - Country:US
Practice Address - Phone:312-208-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1074797133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered