Provider Demographics
NPI:1780671297
Name:MOTTICE, GRETCHEN (MS,RD,LDN,CDE,BCADM)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MOTTICE
Suffix:
Gender:F
Credentials:MS,RD,LDN,CDE,BCADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8716 COURAGE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-8205
Mailing Address - Country:US
Mailing Address - Phone:919-816-5776
Mailing Address - Fax:
Practice Address - Street 1:8716 COURAGE CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-8205
Practice Address - Country:US
Practice Address - Phone:919-816-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4771133V00000X
NCL002987133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND 4771OtherDIETITIAN LICENSE
NCL002987OtherNC BOARD OF DIETETICS
MD407SMedicare ID - Type UnspecifiedMEDICARE PROVIDER