Healthcare Provider Details

I. General information

NPI: 1366208076
Provider Name (Legal Business Name): LANCASTER NUTRITION AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 HIGHLAND FOREST DR
WAXHAW NC
28173-7366
US

IV. Provider business mailing address

2206 HIGHLAND FOREST DR
WAXHAW NC
28173-7366
US

V. Phone/Fax

Practice location:
  • Phone: 704-737-6408
  • Fax:
Mailing address:
  • Phone: 704-737-6408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: DIANE LANCASTER
Title or Position: RD
Credential:
Phone: 704-737-6408