Healthcare Provider Details

I. General information

NPI: 1538238944
Provider Name (Legal Business Name): MEROE HENRY WHEATLEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 BURNT MILL DRIVE
WILMINGTON NC
28403-2654
US

IV. Provider business mailing address

320 SABRA DRIVE
WILMINGTON NC
28405
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-5817
  • Fax: 910-251-2652
Mailing address:
  • Phone: 910-524-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: