Provider Demographics
NPI:1639522287
Name:GREENE, RENEE L (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:L
Last Name:GREENE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 TATE BLVD SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1384
Mailing Address - Country:US
Mailing Address - Phone:828-485-2300
Mailing Address - Fax:828-485-2304
Practice Address - Street 1:1501 TATE BLVD SE
Practice Address - Street 2:SUITE 103
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1384
Practice Address - Country:US
Practice Address - Phone:828-485-2300
Practice Address - Fax:828-485-2304
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004554133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered