Provider Demographics
NPI:1902100126
Name:NEAL, HEATHER ELISE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELISE
Last Name:NEAL
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 1:3606 TWO OAKS DR
Mailing Address - Street 2:GREENSBORO
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9708
Mailing Address - Country:US
Mailing Address - Phone:443-745-8165
Mailing Address - Fax:336-790-6779
Practice Address - Street 1:3606 TWO OAKS DR
Practice Address - Street 2:GREENSBORO
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9708
Practice Address - Country:US
Practice Address - Phone:443-745-8165
Practice Address - Fax:336-790-6779
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered