Provider Demographics
NPI:1366615890
Name:VENEZIA, AHNA GREGORY (RD, LD, CN)
Entity type:Individual
Prefix:MRS
First Name:AHNA
Middle Name:GREGORY
Last Name:VENEZIA
Suffix:
Gender:F
Credentials:RD, LD, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 TAYLOR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1587
Mailing Address - Country:US
Mailing Address - Phone:502-458-4588
Mailing Address - Fax:
Practice Address - Street 1:3010 TAYLOR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1587
Practice Address - Country:US
Practice Address - Phone:502-458-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0987133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric