Provider Demographics
NPI:1922692623
Name:DELK, LAURIE (MS, CNS, LN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:DELK
Suffix:
Gender:F
Credentials:MS, CNS, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W SKYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2821
Mailing Address - Country:US
Mailing Address - Phone:619-606-6212
Mailing Address - Fax:
Practice Address - Street 1:112 W SKYHAWK DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2821
Practice Address - Country:US
Practice Address - Phone:619-606-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNU000009133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist