Provider Demographics
NPI:1669162756
Name:BRADDICK, JEANNE ANN I (RD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANN
Last Name:BRADDICK
Suffix:I
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 1:43 STONERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5578
Mailing Address - Country:US
Mailing Address - Phone:201-315-4085
Mailing Address - Fax:
Practice Address - Street 1:20 DUKE MEDICINE CIR RM 5N61
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-2000
Practice Address - Country:US
Practice Address - Phone:919-613-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006843133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology