Provider Demographics
NPI:1457088163
Name:WARREN, TASHA SMITH (RD, LDN, LNHA, CALA)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:SMITH
Last Name:WARREN
Suffix:
Gender:F
Credentials:RD, LDN, LNHA, CALA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051-0893
Mailing Address - Country:US
Mailing Address - Phone:336-817-2262
Mailing Address - Fax:
Practice Address - Street 1:500 W HANES MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-9814
Practice Address - Country:US
Practice Address - Phone:336-793-0532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC816668133V00000X
NC2068376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No376G00000XNursing Service Related ProvidersNursing Home Administrator