Provider Demographics
NPI:1598063570
Name:GREEN, LAUREN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-6009
Mailing Address - Country:US
Mailing Address - Phone:607-738-3313
Mailing Address - Fax:
Practice Address - Street 1:328 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-6009
Practice Address - Country:US
Practice Address - Phone:607-738-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004396133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic