Provider Demographics
NPI:1982949012
Name:BENFIELD, DEBRA LEE (MED, RD, LDN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:BENFIELD
Suffix:
Gender:F
Credentials:MED, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 FENIMORE ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3713
Mailing Address - Country:US
Mailing Address - Phone:336-773-1443
Mailing Address - Fax:
Practice Address - Street 1:623 FENIMORE ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3713
Practice Address - Country:US
Practice Address - Phone:336-773-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000741133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered