MEDICARE: MS. MICHELLE M MIELKE MBA, RD, LDN, CDE

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	L003186	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L003186	OTHER	NC	NC BOARD OF DIETETICS/NUTRITION

General Provider Information

NPI Number	:	1447346655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE M MIELKE MBA, RD, LDN, CDE

Provider Business Mailing Address
First Line	:	300 MEADOWMONT VILLAGE CIR
Second Line	:	SUITE 125
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-7518
Country	:	US
Telephone Number	:	984-974-2935
Fax Number	:	984-974-2946

Provider Business Practice Location Address
First Line	:	300 MEADOWMONT VILLAGE CIR
Second Line	:	SUITE 125
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-7518
Country	:	US
Telephone Number	:	984-974-2935
Fax Number	:	984-974-2946

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	02/23/2017

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