Provider Demographics
NPI:1265106595
Name:GAMPE, MARIEL MARIE (MS RD LDN)
Entity type:Individual
Prefix:MS
First Name:MARIEL
Middle Name:MARIE
Last Name:GAMPE
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 APPLE BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3644
Mailing Address - Country:US
Mailing Address - Phone:919-389-9770
Mailing Address - Fax:
Practice Address - Street 1:7540 MIDDLESEX CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NC
Practice Address - Zip Code:27557-8654
Practice Address - Country:US
Practice Address - Phone:252-235-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86119862133V00000X
NCL006541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered