Provider Demographics
NPI:1518105063
Name:PEARSON, MARTA A (RD,LDN,MPH)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:A
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RD,LDN,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2068
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-2068
Mailing Address - Country:US
Mailing Address - Phone:252-342-5755
Mailing Address - Fax:
Practice Address - Street 1:1412 SHEPARD ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4054
Practice Address - Country:US
Practice Address - Phone:252-342-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002766133V00000X
FLND5132133V00000X
GALD003113133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered