Healthcare Provider Details

I. General information

NPI: 1417931882
Provider Name (Legal Business Name): PATRICIA CHERRY LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 SUMMIT CROSSING PL SUITE #306
GASTONIA NC
28054-2104
US

IV. Provider business mailing address

1316 MIDWOOD DR
GASTONIA NC
28052-5255
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-7830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberL000742
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: