Provider Demographics
NPI:1568646248
Name:NYBERG, MARIE HARVIN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:HARVIN
Last Name:NYBERG
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:MARIE
Other - Last Name:HARVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:301 N HERMAN ST
Mailing Address - Street 2:BOX CC WIC
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-2973
Mailing Address - Country:US
Mailing Address - Phone:919-731-1222
Mailing Address - Fax:
Practice Address - Street 1:301 N HERMAN ST
Practice Address - Street 2:BOX CC WIC
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2973
Practice Address - Country:US
Practice Address - Phone:919-731-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002976133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist