Provider Demographics
NPI:1689236903
Name:GENATT, DENEEN (RDN, LD)
Entity Type:Individual
Prefix:
First Name:DENEEN
Middle Name:
Last Name:GENATT
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 CHARLESFORT WAY
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8883
Mailing Address - Country:US
Mailing Address - Phone:843-291-1933
Mailing Address - Fax:
Practice Address - Street 1:187 CHARLESFORT WAY
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-8883
Practice Address - Country:US
Practice Address - Phone:843-291-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1664133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered