Provider Demographics
NPI:1447346655
Name:MIELKE, MICHELLE M (MBA, RD, LDN, CDE)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:MIELKE
Suffix:
Gender:F
Credentials:MBA, RD, LDN, CDE
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEADOWMONT VILLAGE CIR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7518
Mailing Address - Country:US
Mailing Address - Phone:984-974-2935
Mailing Address - Fax:984-974-2946
Practice Address - Street 1:300 MEADOWMONT VILLAGE CIR
Practice Address - Street 2:SUITE 125
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7518
Practice Address - Country:US
Practice Address - Phone:984-974-2935
Practice Address - Fax:984-974-2946
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCL003186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL003186OtherNC BOARD OF DIETETICS/NUTRITION