Provider Demographics
NPI:1003111279
Name:STUART, NAOMI (RD)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 HAMMERSMITH DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7061
Mailing Address - Country:US
Mailing Address - Phone:252-439-0986
Mailing Address - Fax:
Practice Address - Street 1:1507 HAMMERSMITH DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7061
Practice Address - Country:US
Practice Address - Phone:252-439-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL0001515133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal