Provider Demographics
NPI:1104609809
Name:GREENER, ELIZABETH (RDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GREENER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ALEXANDER CT APT 113
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1156
Mailing Address - Country:US
Mailing Address - Phone:732-859-6928
Mailing Address - Fax:
Practice Address - Street 1:300 ALEXANDER CT APT 113
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1156
Practice Address - Country:US
Practice Address - Phone:732-859-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007624133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered