Provider Demographics
NPI:1851783898
Name:GREENWELL, KATHERINE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5383 OPIHI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1921
Mailing Address - Country:US
Mailing Address - Phone:808-779-3796
Mailing Address - Fax:
Practice Address - Street 1:5383 OPIHI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1921
Practice Address - Country:US
Practice Address - Phone:808-779-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI994402133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered