Healthcare Provider Details

I. General information

NPI: 1649095894
Provider Name (Legal Business Name): CAMERON BOVAIS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 HEATHER RD
BURLINGTON NC
27215-6288
US

IV. Provider business mailing address

873 HEATHER RD
BURLINGTON NC
27215-6288
US

V. Phone/Fax

Practice location:
  • Phone: 336-570-3494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberL006228
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: