MEDICARE: NATALIE FAUSTYN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	L006172	NC

General Provider Information

NPI Number	:	1235092578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE FAUSTYN

Provider Business Mailing Address
First Line	:	1714 CANTERBURY RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27608-1110
Country	:	US
Telephone Number	:	919-213-0504
Fax Number	:

Provider Business Practice Location Address
First Line	:	1053 E WHITAKER MILL RD STE 115
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-5305
Country	:	US
Telephone Number	:	919-213-0504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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