Healthcare Provider Details

I. General information

NPI: 1558969618
Provider Name (Legal Business Name): ANNIKA ROCKWELL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 GLENWOOD AVE STE 200 PMB 1053
RALEIGH NC
27612-3857
US

IV. Provider business mailing address

4801 GLENWOOD AVE STE 200 PMB 1053
RALEIGH NC
27612-3857
US

V. Phone/Fax

Practice location:
  • Phone: 919-275-3221
  • Fax: 919-300-8879
Mailing address:
  • Phone: 919-275-3221
  • Fax: 919-300-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: