Provider Demographics
NPI:1801156294
Name:RIORDAN, PENELOPE J (RD, LDN)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:J
Last Name:RIORDAN
Suffix:
Gender:F
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 1:389 N HIDDENBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7320
Mailing Address - Country:US
Mailing Address - Phone:336-998-2352
Mailing Address - Fax:
Practice Address - Street 1:389 N HIDDENBROOKE DR
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-7320
Practice Address - Country:US
Practice Address - Phone:336-998-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001756133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered