Healthcare Provider Details

I. General information

NPI: 1992895809
Provider Name (Legal Business Name): PATRICIA ALSTON TAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2325
US

IV. Provider business mailing address

107 BOUNTY LN
DURHAM NC
27713-2303
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-4044
  • Fax: 919-956-4558
Mailing address:
  • Phone: 919-544-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: