Healthcare Provider Details

I. General information

NPI: 1225613433
Provider Name (Legal Business Name): LAURIE DELK NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W SKYHAWK DR
CARY NC
27513-2821
US

IV. Provider business mailing address

112 W SKYHAWK DR
CARY NC
27513-2821
US

V. Phone/Fax

Practice location:
  • Phone: 619-606-6212
  • Fax:
Mailing address:
  • Phone: 619-606-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: LAURIE DELK
Title or Position: OWNER, NUTRITIONIST
Credential: MS, CNS, LN
Phone: 619-606-6212