Provider Demographics
NPI:1144538042
Name:MONTESANO-BALLANCE, MARIA ANTONIETTA (MS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ANTONIETTA
Last Name:MONTESANO-BALLANCE
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 B HOWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570
Mailing Address - Country:US
Mailing Address - Phone:252-223-3914
Mailing Address - Fax:252-223-3905
Practice Address - Street 1:361 B HOWARD BOULEVARD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-7034
Practice Address - Country:US
Practice Address - Phone:252-223-3914
Practice Address - Fax:252-223-3905
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003248133V00000X
NC959266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered