Healthcare Provider Details

I. General information

NPI: 1871015784
Provider Name (Legal Business Name): REBECCA ANN SKOTEK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MACGREGOR PINES DR STE 310
CARY NC
27511
US

IV. Provider business mailing address

PO BOX 602195
CHARLOTTE NC
28260-2195
US

V. Phone/Fax

Practice location:
  • Phone: 919-234-4468
  • Fax: 919-234-4650
Mailing address:
  • Phone: 919-234-4468
  • Fax: 919-234-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL005233
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: