Provider Demographics
NPI:1083330658
Name:LOPEZ, NADIA MONET (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:MONET
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 RAVENS WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-0121
Mailing Address - Country:US
Mailing Address - Phone:318-658-4861
Mailing Address - Fax:
Practice Address - Street 1:81 RAVENS WOOD CIR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-0121
Practice Address - Country:US
Practice Address - Phone:318-658-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86116465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered