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General NPI Number Information
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NPI Number | 1134947419
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Entity Type | Organization
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Legal Business Name | COGNITIVE NUTRIENT THERAPY
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 301 ASHVILLE AVENUE SUITE 111
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City | CARY
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State | NC
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Zip | 27518
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Country | US
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Telephone | 984-464-0114
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Fax | 919-932-0854
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Provider Business Mailing Address
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Address Line | 301 ASHVILLE AVENUE SUITE 111
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City | CARY
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State | NC
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Zip | 27518
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Country | US
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Telephone | 984-464-0114
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Fax | 919-932-0854
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Authorized Official
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Title or Position | CEO
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Name | MELANIE MINTZER
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Credential | MD
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Telephone | 919-667-4649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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