Provider Demographics
NPI:1699842369
Name:LESKO-ROBERTS, BONNIE RAE (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:RAE
Last Name:LESKO-ROBERTS
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 1:1137 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0835
Mailing Address - Country:US
Mailing Address - Phone:252-902-4649
Mailing Address - Fax:
Practice Address - Street 1:201 GOVERNMENT CIR
Practice Address - Street 2:PITT COUNTY PUBLIC HEALTH CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8198
Practice Address - Country:US
Practice Address - Phone:252-902-2386
Practice Address - Fax:252-413-1446
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4224133V00000X
NCL001625133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered