Provider Demographics
NPI:1912679648
Name:GHOFRANI, VANESSA (RD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:GHOFRANI
Suffix:
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 1:109 PAINTED TURTLE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-1533
Mailing Address - Country:US
Mailing Address - Phone:919-633-5796
Mailing Address - Fax:
Practice Address - Street 1:109 PAINTED TURTLE LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-1533
Practice Address - Country:US
Practice Address - Phone:919-633-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered