Provider Demographics
NPI:1538909288
Name:GREENWAY, KELLY (FNTP, MRWP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:GREENWAY
Suffix:
Gender:F
Credentials:FNTP, MRWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S THIRD AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1358
Mailing Address - Country:US
Mailing Address - Phone:208-290-8856
Mailing Address - Fax:
Practice Address - Street 1:123 S THIRD AVE STE 6
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1358
Practice Address - Country:US
Practice Address - Phone:208-290-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist