Healthcare Provider Details

I. General information

NPI: 1750665493
Provider Name (Legal Business Name): LAURA E. MATARESE PHD, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MOYE BLVD
GREENVILLE NC
27834-2849
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-1400
  • Fax: 252-744-2899
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberL003852
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: