Provider Demographics
NPI:1770088288
Name:GREENE, BRITTANY ELIZABETH (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ELIZABETH
Last Name:GREENE
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:ELIZABETH
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LDN
Mailing Address - Street 1:12311 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8344
Mailing Address - Country:US
Mailing Address - Phone:724-941-7490
Mailing Address - Fax:724-941-5231
Practice Address - Street 1:12311 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8344
Practice Address - Country:US
Practice Address - Phone:724-941-7490
Practice Address - Fax:724-941-5231
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006027133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036316970001Medicaid