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Individual

GEORGETTE RAVENHALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RDN, CDN

Contact information

Practice address
17 WILL BUTLER LANE, BREMEN, ME 04551-0455
(631) 219-8929
Mailing address
625 BELLE TERRE RD STE 202, PORT JEFFERSON, NY 11777-2318
(631) 686-2513

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
86063967
NY
133V00000X
Registered Dietitian
DI1773
ME
133V00000X
Registered Dietitian
Primary

Other

Enumeration date
05/10/2018
Last updated
02/14/2023
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