Provider Demographics
NPI:1386811339
Name:SIMPSON, NANCY COSTANZO (RD LDN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:COSTANZO
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-802-2900
Mailing Address - Fax:336-802-2901
Practice Address - Street 1:1208 EASTCHESTER DR STE 107
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3066
Practice Address - Country:US
Practice Address - Phone:336-802-2900
Practice Address - Fax:336-802-2901
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001174133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered