Healthcare Provider Details

I. General information

NPI: 1477768133
Provider Name (Legal Business Name): CHRISTINA M KOCHUBA MA LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

143 W FRANKLIN ST
CHAPEL HILL NC
27516-2539
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-8596
  • Fax: 919-843-5515
Mailing address:
  • Phone: 919-966-8596
  • Fax: 919-843-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003014
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: