Provider Demographics
NPI:1811367980
Name:GRAMLICK, RENE NICOLE (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:RENE
Middle Name:NICOLE
Last Name:GRAMLICK
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 1:2875 OLD CLARKSVILLE SPGFLD RD
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:TN
Mailing Address - Zip Code:37010-8972
Mailing Address - Country:US
Mailing Address - Phone:931-220-7560
Mailing Address - Fax:
Practice Address - Street 1:2875 OLD CLARKSVILLE SPGFLD RD
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:TN
Practice Address - Zip Code:37010-8972
Practice Address - Country:US
Practice Address - Phone:931-220-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1824133V00000X
KYBDNDTN00220292133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered