Provider Demographics
NPI:1588174098
Name:GREENAWALT, LAINE (RD)
Entity type:Individual
Prefix:
First Name:LAINE
Middle Name:
Last Name:GREENAWALT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LAINE
Other - Middle Name:
Other - Last Name:PITCAIRN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:335 OLD GILKESON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1062
Mailing Address - Country:US
Mailing Address - Phone:484-363-1008
Mailing Address - Fax:
Practice Address - Street 1:335 OLD GILKESON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-1062
Practice Address - Country:US
Practice Address - Phone:484-363-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5371-29133V00000X
GALD006708133V00000X
AR2553133V00000X
TXDT89802133V00000X
FLND13386133V00000X
PADN006305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037389330001Medicaid