MEDICARE: MS. PETULA KWENDE MPH, 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	L002327	NC

General Provider Information

NPI Number	:	1881876662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PETULA KWENDE MPH, RD, LDN

Provider Business Mailing Address
First Line	:	5315 AMITY SPRINGS DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-3648
Country	:	US
Telephone Number	:	704-222-6107
Fax Number	:

Provider Business Practice Location Address
First Line	:	5315 AMITY SPRINGS DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-3648
Country	:	US
Telephone Number	:	704-222-6107
Fax Number	:

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

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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