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General NPI Number Information
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NPI Number | 1487099511
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Entity Type | Individual
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Provider Name | MRS. TERAH NICOLE STARBUCK
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Gender | Female
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 428 E 4TH ST
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City | CHARLOTTE
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State | NC
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Zip | 28202-2434
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Country | US
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Telephone | 704-380-4655
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 EMERYWOOD DR
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City | CHARLOTTE
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State | NC
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Zip | 28210-4142
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Country | US
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Telephone | 336-692-8080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | L003814
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License Number State | NC
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