Provider Demographics
NPI:1558014829
Name:MURPHY, RENATA (CNS)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 WILD HAWTHORN WAY
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1021
Mailing Address - Country:US
Mailing Address - Phone:703-725-4370
Mailing Address - Fax:
Practice Address - Street 1:1230 WILD HAWTHORN WAY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-1021
Practice Address - Country:US
Practice Address - Phone:571-248-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5507133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education