Provider Demographics
NPI:1154773398
Name:GREENWAY, MOLLIE JEAN (MS, RD, LN)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:JEAN
Last Name:GREENWAY
Suffix:
Gender:F
Credentials:MS, RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 WINSOR CT
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-6408
Mailing Address - Country:US
Mailing Address - Phone:605-380-2294
Mailing Address - Fax:
Practice Address - Street 1:2808 WINSOR CT
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-6408
Practice Address - Country:US
Practice Address - Phone:605-380-2294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered