Healthcare Provider Details

I. General information

NPI: 1891922175
Provider Name (Legal Business Name): ELIZABETH GIBSON DUNN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR DEPT OF FOOD & NUTRITION
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

211 FRIDAY CENTER DR SUITE 2091, ROOM 2097
CHAPEL HILL NC
27517-9499
US

V. Phone/Fax

Practice location:
  • Phone: 919-843-0062
  • Fax:
Mailing address:
  • Phone: 919-966-5804
  • Fax: 919-966-9983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002387
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: