MEDICARE: LAYNE HUNTINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	L005145	NC

General Provider Information

NPI Number	:	1639002975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAYNE HUNTINGTON

Provider Business Mailing Address
First Line	:	3149 SUNCREST VILLAGE LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-8862
Country	:	US
Telephone Number	:	919-260-8601
Fax Number	:

Provider Business Practice Location Address
First Line	:	3149 SUNCREST VILLAGE LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-8862
Country	:	US
Telephone Number	:	919-260-8601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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