Provider Demographics
NPI:1336773654
Name:PRUENTE, CAROLINE FRANCES (MS, RDN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:FRANCES
Last Name:PRUENTE
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6263 POPLAR AVE STE 605
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4724
Mailing Address - Country:US
Mailing Address - Phone:615-948-2626
Mailing Address - Fax:901-328-1802
Practice Address - Street 1:6263 POPLAR AVE STE 605
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4724
Practice Address - Country:US
Practice Address - Phone:615-948-2626
Practice Address - Fax:901-328-1802
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3684133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE