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General NPI Number Information
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NPI Number | 1801079298
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Entity Type | Individual
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Provider Name | MICHELLE LILA BLITSTEIN M.S. R.D.
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Gender | Female
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Dates
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Enumeration Date | 12/09/2007
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 4812 CARMEL PARK DR
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City | CHARLOTTE
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State | NC
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Zip | 28226-5131
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Country | US
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Telephone | 704-491-5616
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Fax | 704-442-6360
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Provider Business Mailing Address
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Address Line | 4812 CARMEL PARK DR
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City | CHARLOTTE
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State | NC
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Zip | 28226-5131
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Country | US
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Telephone | 704-491-5616
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Fax | 704-892-2212
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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 | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | L001566
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License Number State | NC
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