Provider Demographics
NPI:1548968514
Name:HUTCHINSON, SERENA (MPH, RDN, LDN, IBCLC)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:MPH, RDN, LDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 GARRETT RD APT 918
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2455
Mailing Address - Country:US
Mailing Address - Phone:425-287-1970
Mailing Address - Fax:
Practice Address - Street 1:219 S EAST ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-2369
Practice Address - Country:US
Practice Address - Phone:919-213-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007181133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty