Individual
KATHRYN FAVREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN, CNSC
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 713-3041
Mailing address
204 DESOTO CT, WINSTON SALEM, NC 27107-6082
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L002415
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
917438
COMMISSION ON DIETETIC REGISTRATION
—
01
—
L002415
NORTH CAROLINA BOARD OF DIETETICS/NUTRITION
NC
Enumeration date
06/25/2019
Last updated
11/27/2023
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