Basic Information
Provider Information | |||||||||
NPI: | 1770771206 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEWELL | ||||||||
FirstName: | NATALIE | ||||||||
MiddleName: | HUGHES | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | R.D., L.D.N. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HUGHES | ||||||||
OtherFirstName: | NATALIE | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RD, LDN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 211 FRIDAY CENTER DR | ||||||||
Address2: | SUITE 2091, ROOM 2094 HEDRICK BUILDING | ||||||||
City: | CHAPEL HILL | ||||||||
State: | NC | ||||||||
PostalCode: | 275179499 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9849741191 | ||||||||
FaxNumber: | 9849741311 | ||||||||
Practice Location | |||||||||
Address1: | 11200 GALLERIA AVE | ||||||||
Address2: |   | ||||||||
City: | RALEIGH | ||||||||
State: | NC | ||||||||
PostalCode: | 276148137 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9195701511 | ||||||||
FaxNumber: | 9195707751 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/10/2007 | ||||||||
LastUpdateDate: | 09/29/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | L002217 | NC | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   | 133N00000X | L002217 | NC | N |   | Dietary & Nutritional Service Providers | Nutritionist |   | 133NN1002X | L002217 | NC | N |   | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
ID Information
ID | Type | State | Issuer | Description | Q50642E853 | 01 | NC | MEDICARE PTAN | OTHER | Q50642A | 01 | NC | MEDICARE PTAN | OTHER |