Individual
MICAH NICOLE TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
760 HIGHLAND OAKS DR STE 200, WINSTON SALEM, NC 27103-7114
(336) 277-4380
(336) 659-0659
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
007461
NC
Other
Enumeration date
08/28/2023
Last updated
09/12/2023
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