Healthcare Provider Details

I. General information

NPI: 1114562675
Provider Name (Legal Business Name): RENEE DANNER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 PETER JEFFERSON PKWY STE 175
CHARLOTTESVILLE VA
22911-4655
US

IV. Provider business mailing address

124 BOXWOOD CT
CHARLOTTESVILLE VA
22902-8260
US

V. Phone/Fax

Practice location:
  • Phone: 434-465-9358
  • Fax:
Mailing address:
  • Phone: 507-405-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: