Healthcare Provider Details

I. General information

NPI: 1548968514
Provider Name (Legal Business Name): SERENA HUTCHINSON MPH, RDN, LDN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S EAST ST
RALEIGH NC
27601-2369
US

IV. Provider business mailing address

4130 GARRETT RD APT 918
DURHAM NC
27707-2455
US

V. Phone/Fax

Practice location:
  • Phone: 919-213-8979
  • Fax:
Mailing address:
  • Phone: 425-287-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL007181
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: