Healthcare Provider Details

I. General information

NPI: 1538573209
Provider Name (Legal Business Name): ANDREA JOYCE ALLEN MPH RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA ALLEN PEARCE

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 LAKE BOONE TRL STE 100
RALEIGH NC
27607-6685
US

IV. Provider business mailing address

68 LONESTAR CT
SMITHFIELD NC
27577-8944
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberL001450
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberL001450
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL001450
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: