Provider Demographics
NPI:1386131027
Name:COLE, MICHELLE (RD, LDN, CDE)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 COPPLES ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-0711
Mailing Address - Country:US
Mailing Address - Phone:336-460-4683
Mailing Address - Fax:910-715-6279
Practice Address - Street 1:520 ALLEN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2802
Practice Address - Country:US
Practice Address - Phone:910-715-6268
Practice Address - Fax:910-715-6279
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC961793133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered