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General NPI Number Information
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NPI Number | 1619271384
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Entity Type | Individual
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Provider Name | JESSICA MARIE LEU M.S, R.D., L.D.N.
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Gender | Female
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 1718 E 4TH ST STE 404
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City | CHARLOTTE
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State | NC
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Zip | 28204-3193
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Country | US
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Telephone | 980-488-9730
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Fax | 980-488-9731
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Provider Business Mailing Address
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Address Line | PO BOX 604136
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City | CHARLOTTE
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State | NC
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Zip | 28260-4136
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Country | US
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Telephone |
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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 | L009495
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1563
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License Number State | TN
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