Healthcare Provider Details

I. General information

NPI: 1801218144
Provider Name (Legal Business Name): JOAN Y MANSFIELD M.P.H., R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GOVERNMENT CIR
GREENVILLE NC
27834-8198
US

IV. Provider business mailing address

201 GOVERNMENT CIR
GREENVILLE NC
27834-8198
US

V. Phone/Fax

Practice location:
  • Phone: 252-902-2361
  • Fax: 252-413-1446
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003640
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: