Individual
RENEE A MATGOURANIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LD/RD
Contact information
Practice address
3435 TROY RD, SPRINGFIELD, OH 45504-4335
(937) 342-8800
(937) 342-8805
Mailing address
31737 LEEWARD CT, AVON LAKE, OH 44012-2926
(440) 933-2234
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2296
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
637662
AMERICAN DIETITIC ASSOCIATION
OH
Enumeration date
10/26/2011
Last updated
11/01/2011
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