Healthcare Provider Details

I. General information

NPI: 1699842369
Provider Name (Legal Business Name): BONNIE RAE LESKO-ROBERTS RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GOVERNMENT CIR PITT COUNTY PUBLIC HEALTH CENTER
GREENVILLE NC
27834-8198
US

IV. Provider business mailing address

1137 TEAKWOOD DR
GREENVILLE NC
27834-0835
US

V. Phone/Fax

Practice location:
  • Phone: 252-902-2386
  • Fax: 252-413-1446
Mailing address:
  • Phone: 252-902-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4224
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL001625
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: