Provider Demographics
NPI:1063817344
Name:THOMPSON, JUNE MARTIN (RDN)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:MARTIN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1417
Mailing Address - Country:US
Mailing Address - Phone:336-254-4534
Mailing Address - Fax:
Practice Address - Street 1:219 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1417
Practice Address - Country:US
Practice Address - Phone:336-254-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001024133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered