Healthcare Provider Details

I. General information

NPI: 1770396491
Provider Name (Legal Business Name): GLORIA WHITFIELD RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 SHANNON RD STE 103
DURHAM NC
27707-6333
US

IV. Provider business mailing address

4705 UNIVERSITY DR BLDG 700
DURHAM NC
27707-3489
US

V. Phone/Fax

Practice location:
  • Phone: 984-263-4029
  • Fax: 252-283-0565
Mailing address:
  • Phone: 919-237-1337
  • Fax: 866-538-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD007396
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL010112
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: