Provider Demographics
NPI:1104667971
Name:SURLES, EMMA JOELLE (RD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:JOELLE
Last Name:SURLES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8548 QUARTON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5597
Mailing Address - Country:US
Mailing Address - Phone:919-802-3453
Mailing Address - Fax:
Practice Address - Street 1:8548 QUARTON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5597
Practice Address - Country:US
Practice Address - Phone:919-802-3453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007810133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered