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NPI Code Detail

MEDICARE: MRS. RENEE ANN DEFRANG RD CDE

MEDICARE: MRS. RENEE ANN DEFRANG RD CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian886452MI

General Provider Information

NPI Number : 1023203718
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RENEE ANN DEFRANG RD CDE
Provider Business Mailing Address
First Line : 407 S NELSON ST
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2138
Country : US
Telephone Number : 616-754-6185
Fax Number : 616-754-6407
Provider Business Practice Location Address
First Line : 407 S NELSON ST
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2138
Country : US
Telephone Number : 616-754-6185
Fax Number : 616-754-6407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2007
Last Update Date : 09/07/2007

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