Provider Demographics
NPI:1881033090
Name:ROCKWELL, MICHELLE (MS, RD, CSSD, LD/N)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:MS, RD, CSSD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PENCADE LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9636
Mailing Address - Country:US
Mailing Address - Phone:919-943-0045
Mailing Address - Fax:
Practice Address - Street 1:5824 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-943-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered