Provider Demographics
NPI:1679593537
Name:CEPULL, PATRICE M (RD, LDN)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:M
Last Name:CEPULL
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:
Other - Last Name:OSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4420 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7505
Mailing Address - Country:US
Mailing Address - Phone:919-784-6594
Mailing Address - Fax:919-784-3180
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-784-6594
Practice Address - Fax:919-784-3180
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002156133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2991928AMedicare PIN