Healthcare Provider Details

I. General information

NPI: 1386317535
Provider Name (Legal Business Name): MSC NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 07/25/2021
Certification Date: 07/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 HILLSBOROUGH RD
DURHAM NC
27705-3008
US

IV. Provider business mailing address

PO BOX 2727
DURHAM NC
27715-2727
US

V. Phone/Fax

Practice location:
  • Phone: 919-210-8497
  • Fax:
Mailing address:
  • Phone: 919-210-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LAURIE MICHELLE CONTEH
Title or Position: PROVIDER
Credential: RD
Phone: 919-210-8497