Provider Demographics
NPI:1629592027
Name:VERGANI, MYRA (MS RD LDN CDE)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:VERGANI
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 1:109 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3301
Mailing Address - Country:US
Mailing Address - Phone:386-864-0365
Mailing Address - Fax:
Practice Address - Street 1:109 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3301
Practice Address - Country:US
Practice Address - Phone:386-864-0365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001643133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered