Healthcare Provider Details

I. General information

NPI: 1518118025
Provider Name (Legal Business Name): MALLORY ANNE ZUECH MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 IREDELL ST
DURHAM NC
27705-4862
US

IV. Provider business mailing address

2728 ARMFIELD ROAD
HILLSBOROUGH NC
27278
US

V. Phone/Fax

Practice location:
  • Phone: 336-681-5272
  • Fax:
Mailing address:
  • Phone: 336-681-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000989672
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: