Provider Demographics
NPI:1972894897
Name:TRIANGLE NUTRITION THERAPY INC
Entity Type:Organization
Organization Name:TRIANGLE NUTRITION THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL AND SPORTS DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:HUGHES
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, CSSD, LDN
Authorized Official - Phone:919-876-9779
Mailing Address - Street 1:6200 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3563
Mailing Address - Country:US
Mailing Address - Phone:919-876-9779
Mailing Address - Fax:
Practice Address - Street 1:6200 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3563
Practice Address - Country:US
Practice Address - Phone:919-876-9779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000996133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty