Provider Demographics
NPI:1205563228
Name:CHUTKAN, MARJORIE ELAINE (RD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ELAINE
Last Name:CHUTKAN
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 1:303 ACADEMIA CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5900
Mailing Address - Country:US
Mailing Address - Phone:239-770-0086
Mailing Address - Fax:
Practice Address - Street 1:118 KNOX WAY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-6610
Practice Address - Country:US
Practice Address - Phone:984-215-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3823133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty