Healthcare Provider Details

I. General information

NPI: 1902457856
Provider Name (Legal Business Name): LUTZ & ALEXANDER NUTRITION THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 WASHINGTON ST
RALEIGH NC
27605-1258
US

IV. Provider business mailing address

1042 WASHINGTON ST
RALEIGH NC
27605-1258
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-4500
  • Fax: 919-781-4504
Mailing address:
  • Phone: 919-781-4500
  • Fax: 919-781-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ANNA METZ LUTZ
Title or Position: REGISTERED DIETITIAN
Credential: MPH, RD, LDN, CEDRD
Phone: 919-781-4500