MEDICARE: MRS. ANNETTE HABECKER RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1312	SC
2	133V00000X	Registered Dietitian	L003989	NC

General Provider Information

NPI Number	:	1053664383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNETTE HABECKER RD, LDN

Provider Business Mailing Address
First Line	:	6135 PARK SOUTH DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3272
Country	:	US
Telephone Number	:	407-408-7242
Fax Number	:

Provider Business Practice Location Address
First Line	:	6135 PARK SOUTH DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3272
Country	:	US
Telephone Number	:	407-408-7242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	03/07/2016

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