Basic Information
Provider Information
NPI: 1659605863
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LESTER
FirstName: JUDY
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: RD, LDN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 211 FRIDAY CENTER DR
Address2: SUITE 2091, ROOM 2097
City: CHAPEL HILL
State: NC
PostalCode: 275179499
CountryCode: US
TelephoneNumber: 9199665804
FaxNumber: 9199669983
Practice Location
Address1: 101 MANNING DR
Address2: DEPT OF NUTRITION
City: CHAPEL HILL
State: NC
PostalCode: 275144220
CountryCode: US
TelephoneNumber: 9198430062
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/22/2009
LastUpdateDate: 09/22/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XL003049NCY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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