Provider Demographics
NPI:1588412407
Name:HARRIENGER, MARY (RD, LDN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HARRIENGER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SPRUCE RUN
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-9612
Mailing Address - Country:US
Mailing Address - Phone:518-764-5019
Mailing Address - Fax:
Practice Address - Street 1:905 W BENTON ST APT 29
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-5937
Practice Address - Country:US
Practice Address - Phone:518-764-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA124990133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered