Provider Demographics
NPI:1164985982
Name:MONICO, ERIN (RDN, CLT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MONICO
Suffix:
Gender:F
Credentials:RDN, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 FALLS OF NEUSE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6849
Mailing Address - Country:US
Mailing Address - Phone:919-913-8620
Mailing Address - Fax:
Practice Address - Street 1:6520 FALLS OF NEUSE RD STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6849
Practice Address - Country:US
Practice Address - Phone:919-913-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005392133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL005392OtherNORTH CAROLINA BOARD OF DIETETICS/NUTRITION