Healthcare Provider Details

I. General information

NPI: 1407931736
Provider Name (Legal Business Name): MARTHA MUNN CAMACHO M.S., R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FAYETTEVILLE ST LINCOLN COMMUNITY HEALTH CENTER
DURHAM NC
27701
US

IV. Provider business mailing address

1612 BRAMBLE DRIVE
DURHAM NC
27712-1212
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-4042
  • Fax:
Mailing address:
  • Phone: 919-471-6561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL000158
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: