MEDICARE: ANDREA MARIE KRENEK RD

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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1396365888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MARIE KRENEK RD

Provider Business Mailing Address
First Line	:	6106 CROSS CREEK HARBOR LN
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-2024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6106 CROSS CREEK HARBOR LN
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-2024
Country	:	US
Telephone Number	:	832-607-8585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	04/24/2020

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