MEDICARE: MS. LAURA JO FLOWERS RD, 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
1	133V00000X	Registered Dietitian	L001919	NC

General Provider Information

NPI Number	:	1396015046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA JO FLOWERS RD, LDN

Provider Business Mailing Address
First Line	:	5610 SAGE HILLS DR
Second Line	:	#720
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0606
Country	:	US
Telephone Number	:	704-287-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	5610 SAGE HILLS DR
Second Line	:	#720
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0606
Country	:	US
Telephone Number	:	704-287-4601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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