Healthcare Provider Details

I. General information

NPI: 1609692979
Provider Name (Legal Business Name): KEEGAN KAWAI ZAVODNIK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 HERNDON RD
DURHAM NC
27713-6315
US

IV. Provider business mailing address

6301 HERNDON RD
DURHAM NC
27713-6315
US

V. Phone/Fax

Practice location:
  • Phone: 919-769-3626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License NumberL008307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: