Provider Demographics
NPI:1750657334
Name:HARLAN, PEGGY SUE (RD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUE
Last Name:HARLAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9494
Mailing Address - Country:US
Mailing Address - Phone:919-731-6087
Mailing Address - Fax:919-731-6794
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9494
Practice Address - Country:US
Practice Address - Phone:919-731-6087
Practice Address - Fax:919-731-6794
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000612133V00000X
NC708510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered