Provider Demographics
NPI:1528816196
Name:GREENE, WHITNEY LEEANN (MS, RD, CSO)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:LEEANN
Last Name:GREENE
Suffix:
Gender:F
Credentials:MS, RD, CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 DAVIS CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-6073
Mailing Address - Country:US
Mailing Address - Phone:408-461-1170
Mailing Address - Fax:
Practice Address - Street 1:3960 DAVIS CT
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-6073
Practice Address - Country:US
Practice Address - Phone:408-461-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86011546133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty