Basic Information
| Provider Information | |||||||||
| NPI: | 1790258176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIDDLE | ||||||||
| FirstName: | EMILIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10208 CERNY ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276171000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193547077 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6350 QUADRANGLE DR STE 135 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275177803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193547077 | ||||||||
| FaxNumber: | 9193547077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2019 | ||||||||
| LastUpdateDate: | 01/08/2019 | ||||||||
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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 | L005586 | NC | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.