Healthcare Provider Details

I. General information

NPI: 1235325218
Provider Name (Legal Business Name): MICHELLE LAND AMBER RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE KAREN LAND RD, LDN

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4389 BEAUFORT RD
HAVELOCK NC
28532
US

IV. Provider business mailing address

4389 BEAUFORT RD
HAVELOCK NC
28532
US

V. Phone/Fax

Practice location:
  • Phone: 252-466-0165
  • Fax:
Mailing address:
  • Phone: 252-466-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002363
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: