Provider Demographics
NPI:1306235627
Name:WHITE, TRENA
Entity type:Individual
Prefix:
First Name:TRENA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 E MAIN ST STE B
Mailing Address - Street 2:116
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 E MAIN ST STE B
Practice Address - Street 2:116
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3717
Practice Address - Country:US
Practice Address - Phone:614-780-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3052133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered