Provider Demographics
NPI:1629412820
Name:JONGKIND, DEBORAH D (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:D
Last Name:JONGKIND
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 MEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2455
Mailing Address - Country:US
Mailing Address - Phone:919-225-3779
Mailing Address - Fax:
Practice Address - Street 1:1829 E FRANKLIN ST STE 1200A
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5838
Practice Address - Country:US
Practice Address - Phone:919-225-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000516133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered