Healthcare Provider Details

I. General information

NPI: 1568626109
Provider Name (Legal Business Name): JANE E. STEGNER MS,RD,LDN,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2393 JEFFERSON AVE
WINSTON SALEM NC
27103-4315
US

IV. Provider business mailing address

2393 JEFFERSON AVE
WINSTON SALEM NC
27103-4315
US

V. Phone/Fax

Practice location:
  • Phone: 336-486-7271
  • Fax:
Mailing address:
  • Phone: 336-486-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberL001325
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: