Healthcare Provider Details

I. General information

NPI: 1902084569
Provider Name (Legal Business Name): MICHELLE MOELHMAN CARNAGHI R.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N CHURCH ST SUITE 400
GREENSBORO NC
27401-1439
US

IV. Provider business mailing address

PO BOX 14883
GREENSBORO NC
27415-4883
US

V. Phone/Fax

Practice location:
  • Phone: 336-378-1076
  • Fax: 336-378-0867
Mailing address:
  • Phone: 336-274-6515
  • Fax: 336-275-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000856
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: