Healthcare Provider Details

I. General information

NPI: 1477708162
Provider Name (Legal Business Name): ESNC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 HOLBROOK ST
HUNTERSVILLE NC
28078-7723
US

IV. Provider business mailing address

PO BOX 921
HUNTERSVILLE NC
28070
US

V. Phone/Fax

Practice location:
  • Phone: 704-779-2100
  • Fax: 704-947-1073
Mailing address:
  • Phone: 704-779-2100
  • Fax: 704-947-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL000910
License Number StateNC

VIII. Authorized Official

Name: MELISSA HERRMANN DIERKS
Title or Position: NUTRITION CONSULTANT
Credential: RD LDN CDE
Phone: 704-779-2100