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NPI Code Detail

MEDICARE: MRS. TARA MICHELLE EICHERT RD, CNSC, LDN

MEDICARE: MRS. TARA MICHELLE EICHERT RD, CNSC, LDN
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 DietitianL003647NC

General Provider Information

NPI Number : 1063712099
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA MICHELLE EICHERT RD, CNSC, LDN
Provider Business Mailing Address
First Line : 218 N 23RD ST
Second Line :
City : WILMINGTON
State : NC
Zip : 28405-2863
Country : US
Telephone Number : 910-792-1231
Fax Number : 910-799-8118
Provider Business Practice Location Address
First Line : 720 SAINT JAMES DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-2937
Country : US
Telephone Number : 910-660-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2010
Last Update Date : 03/17/2018

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