Provider Demographics
NPI:1205989498
Name:GROON, ANDREA F (RD LDN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:F
Last Name:GROON
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7632
Mailing Address - Country:US
Mailing Address - Phone:919-787-8019
Mailing Address - Fax:
Practice Address - Street 1:2631 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7632
Practice Address - Country:US
Practice Address - Phone:919-787-8019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC427133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered