Healthcare Provider Details

I. General information

NPI: 1750593422
Provider Name (Legal Business Name): EMILY M TOOLEY RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 US HWY 64 EAST
PLYMOUTH NC
27962-9216
US

IV. Provider business mailing address

PO BOX 707
PLYMOUTH NC
27962-0707
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-4135
  • Fax: 252-793-1530
Mailing address:
  • Phone: 252-793-4135
  • Fax: 252-793-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberL001010
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL001010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: