Basic Information
| Provider Information | |||||||||
| NPI: | 1760816839 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUGEN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | LAYKISH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, RD, LDN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 629 | ||||||||
| Address2: | 211 VIRGINIA ROAD | ||||||||
| City: | EDENTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279320629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524828451 | ||||||||
| FaxNumber: | 2524826224 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 VIRGINIA RD | ||||||||
| Address2: | |||||||||
| City: | EDENTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279329668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524828451 | ||||||||
| FaxNumber: | 2524826224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2013 | ||||||||
| LastUpdateDate: | 09/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | L000898 | NC | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.