Provider Demographics
NPI:1003135237
Name:HALE, DEMERA JAMIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:DEMERA
Middle Name:JAMIE
Last Name:HALE
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 1:423 S HAWTHORNE RD
Mailing Address - Street 2:APT D
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3787
Mailing Address - Country:US
Mailing Address - Phone:909-556-0116
Mailing Address - Fax:
Practice Address - Street 1:1009 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016
Practice Address - Country:US
Practice Address - Phone:336-593-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA954464133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered