Healthcare Provider Details

I. General information

NPI: 1447497342
Provider Name (Legal Business Name): DANA MERCER CRISP RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S MAIN ST
ROBBINSVILLE NC
28771-9054
US

IV. Provider business mailing address

563 JUTTS CREEK RD
ROBBINSVILLE NC
28771-7274
US

V. Phone/Fax

Practice location:
  • Phone: 828-479-7900
  • Fax: 828-479-6956
Mailing address:
  • Phone: 828-479-4052
  • Fax: 828-479-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002615
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: