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WILMINGTON HEALTH ACCESS FOR TEENS NPI 1790093094


NPI Information

NPI: 1790093094
Provider Name: WILMINGTON HEALTH ACCESS FOR TEENS
Classification: Dietitian, Registered - 133V00000X
Entity Type: Organization

CLIA Number: 34D0923036

Address:
4005 OLEANDER DR
WILMINGTON, NC
ZIP 28403
Phone: (910) 790-9949
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WILMINGTON HEALTH ACCESS FOR TEENS is a dietitian registered in Wilmington, NC. The provider is a Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation. WILMINGTON HEALTH ACCESS FOR TEENS NPI is 1790093094. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4005 OLEANDER DR
WILMINGTON, NC
ZIP 28403-816
Phone: (910) 790-9949
Fax: (910) 790-9455

The provider's authorized official is Maria G Van De Bovenkamp .
The authorized official title is Director Of Administration and has the following contact phone number (910) 790-9949.

The CLIA number assigned to this NPI record is 34D0923036 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/21/2010 and was last updated on 9/21/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1133V00000XDietitian, RegisteredL003170NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10108QOTHERNORTH CAROLINABCBS
22344516MEDICARE UPINNORTH CAROLINA
3890108QMEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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