Provider Demographics
NPI:1043506587
Name:PESCE, TRACEY MITCHELL (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:MITCHELL
Last Name:PESCE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 889
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721
Mailing Address - Country:US
Mailing Address - Phone:803-313-7450
Mailing Address - Fax:803-313-7194
Practice Address - Street 1:509 HUBBARD DRIVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-313-7450
Practice Address - Fax:803-313-7194
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC813484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered