Provider Demographics
NPI:1083006092
Name:EBERSOHL, MEREDITH JOHNSON (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JOHNSON
Last Name:EBERSOHL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:CHRISTINA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 NEW BERN AVE
Mailing Address - Street 2:ENERGIZE PROGRAM
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-618-4656
Mailing Address - Fax:
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:ENERGIZE PROGRAM
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-618-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004569133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered