Provider Demographics
NPI:1568626109
Name:STEGNER, JANE E (MS,RD,LDN,CDE)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:STEGNER
Suffix:
Gender:F
Credentials:MS,RD,LDN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4315
Mailing Address - Country:US
Mailing Address - Phone:336-486-7271
Mailing Address - Fax:
Practice Address - Street 1:2393 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4315
Practice Address - Country:US
Practice Address - Phone:336-486-7271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001325133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2993283AMedicare PIN