Provider Demographics
NPI:1962708313
Name:GRUETZNER, CAROL (RD/LD)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:GRUETZNER
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-7207
Mailing Address - Country:US
Mailing Address - Phone:512-718-4407
Mailing Address - Fax:
Practice Address - Street 1:618 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-7207
Practice Address - Country:US
Practice Address - Phone:512-718-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT02717133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered