Provider Demographics
NPI:1164209516
Name:OSIKA, NOELLE (RD)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:OSIKA
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 1:5804 PRIORESS DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1365
Mailing Address - Country:US
Mailing Address - Phone:252-367-0341
Mailing Address - Fax:
Practice Address - Street 1:1025 WADE AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1158
Practice Address - Country:US
Practice Address - Phone:919-865-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered