Provider Demographics
NPI:1740086024
Name:FLORENCE, WILLIAM WINFIELD (RD, LDN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WINFIELD
Last Name:FLORENCE
Suffix:
Gender:
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CENTENNIAL PKWY APT 106
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3255
Mailing Address - Country:US
Mailing Address - Phone:336-549-3266
Mailing Address - Fax:
Practice Address - Street 1:625 CENTENNIAL PKWY APT 106
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3255
Practice Address - Country:US
Practice Address - Phone:336-549-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005025133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty