Individual
MRS. SHANNON L RENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.,L.D.
Contact information
Practice address
1400 W HEBRON PKWY, CARROLLTON, TX 75010-6515
(214) 789-5563
Mailing address
1400 W HEBRON PKWY, CARROLLTON, TX 75010-6515
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT80836
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548506694
BLUE CROSS BLUE SHIELD OF TEXAS
TX
01
—
1548506694
UNITED HEALTH CARE
—
Enumeration date
03/21/2013
Last updated
03/21/2013
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