Healthcare Provider Details

I. General information

NPI: 1619325529
Provider Name (Legal Business Name): LAURIE REIRIZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 WESTFIELD RD
CHARLOTTE NC
28209-1641
US

IV. Provider business mailing address

2823 WESTFIELD RD
CHARLOTTE NC
28209-1641
US

V. Phone/Fax

Practice location:
  • Phone: 704-609-1845
  • Fax: 704-552-0715
Mailing address:
  • Phone: 704-609-1845
  • Fax: 704-552-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberL001848
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: