Provider Demographics
NPI:1033852520
Name:BLANCHARD, PATRICK (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 BAPTIST CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:GODWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28344-8626
Mailing Address - Country:US
Mailing Address - Phone:910-523-1711
Mailing Address - Fax:
Practice Address - Street 1:3760 BAPTIST CHAPEL RD
Practice Address - Street 2:
Practice Address - City:GODWIN
Practice Address - State:NC
Practice Address - Zip Code:28344-8626
Practice Address - Country:US
Practice Address - Phone:910-523-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005483133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered