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Individual
MS. CAROL GREEN FENWICK
Active
Individual
MS. CAROL GREEN FENWICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
674
DIETETICS PRACTICE LICENSE
SC
Enumeration date
03/01/2007
Last updated
05/11/2011
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