Provider Demographics
NPI:1821794678
Name:LECRONE, RAEGAN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:RAEGAN
Middle Name:
Last Name:LECRONE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 ALLEGHENY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2408
Mailing Address - Country:US
Mailing Address - Phone:814-931-3399
Mailing Address - Fax:
Practice Address - Street 1:1112 ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2408
Practice Address - Country:US
Practice Address - Phone:814-931-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007997133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered