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NPI Code Detail

MEDICARE: MRS. SHARON LEIGH LEWIS-HACKLER MS, RD, LDN, LD, CDE

MEDICARE: MRS. SHARON LEIGH LEWIS-HACKLER MS, RD, LDN, LD, CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian9SC
2133V00000XRegistered DietitianL002396NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11822ROTHERNCBCBS NC

General Provider Information

NPI Number : 1053540377
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHARON LEIGH LEWIS-HACKLER MS, RD, LDN, LD, CDE
Provider Business Mailing Address
First Line : 2609 WEST ARLINGTON BLVD, SUITE 106
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-3796
Country : US
Telephone Number : 252-689-6303
Fax Number : 252-689-6304
Provider Business Practice Location Address
First Line : 1540 E ARLINGTON BLVD
Second Line :
City : GREENVILLE
State : NC
Zip : 27858-5870
Country : US
Telephone Number : 252-364-2806
Fax Number : 252-364-2863
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2009
Last Update Date : 06/02/2022

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