Provider Demographics
NPI:1881231843
Name:THE COMPOSITION DIETITIAN
Entity Type:Organization
Organization Name:THE COMPOSITION DIETITIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RD
Authorized Official - Prefix:
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:MERLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:919-909-4601
Mailing Address - Street 1:1804 MIDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2325
Mailing Address - Country:US
Mailing Address - Phone:919-909-4601
Mailing Address - Fax:
Practice Address - Street 1:1804 MIDWOOD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2325
Practice Address - Country:US
Practice Address - Phone:919-909-4601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty