Provider Demographics
NPI:1033554878
Name:PUTNAM, JANICE (RD, LDN, CDE)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:P
Other - Last Name:SCROGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN, CDE
Mailing Address - Street 1:319 N GRAHAM - HOPEDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217
Mailing Address - Country:US
Mailing Address - Phone:336-570-6474
Mailing Address - Fax:336-570-6535
Practice Address - Street 1:319 N GRAHAM - HOPEDALE ROAD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217
Practice Address - Country:US
Practice Address - Phone:336-570-6474
Practice Address - Fax:336-570-6535
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCR000624738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00709Medicaid