Healthcare Provider Details

I. General information

NPI: 1902526643
Provider Name (Legal Business Name): JENNIFER REED FUNSTEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 FAIRVIEW RD STE 106
CHARLOTTE NC
28209-3649
US

IV. Provider business mailing address

4705 UNIVERSITY DR BLDG 700
DURHAM NC
27707-3489
US

V. Phone/Fax

Practice location:
  • Phone: 704-826-3550
  • Fax:
Mailing address:
  • Phone: 919-237-1337
  • Fax: 866-538-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL007084
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: