Provider Demographics
NPI:1821501289
Name:MICKELSON, MARGARET GEHRING (RD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:GEHRING
Last Name:MICKELSON
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 1:512 GRAND OAK DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8851
Mailing Address - Country:US
Mailing Address - Phone:919-477-3751
Mailing Address - Fax:
Practice Address - Street 1:101 HUNT DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3497
Practice Address - Country:US
Practice Address - Phone:919-693-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002754133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered