Healthcare Provider Details

I. General information

NPI: 1598063570
Provider Name (Legal Business Name): LAUREN GREEN MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 E JEFFERSON ST
BUTLER PA
16001-6009
US

IV. Provider business mailing address

328 E JEFFERSON ST
BUTLER PA
16001-6009
US

V. Phone/Fax

Practice location:
  • Phone: 607-738-3313
  • Fax:
Mailing address:
  • Phone: 607-738-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDN004396
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: