Provider Demographics
NPI:1689807810
Name:RENFRO, DIANA H (RD, MS, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:H
Last Name:RENFRO
Suffix:
Gender:F
Credentials:RD, MS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 MCCONNELL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9772
Mailing Address - Country:US
Mailing Address - Phone:336-246-2013
Mailing Address - Fax:336-246-8163
Practice Address - Street 1:413 MCCONNELL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9772
Practice Address - Country:US
Practice Address - Phone:336-246-2013
Practice Address - Fax:336-246-8163
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered