Provider Demographics
NPI:1053664383
Name:HABECKER, ANNETTE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:HABECKER
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 1:6135 PARK SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3272
Mailing Address - Country:US
Mailing Address - Phone:407-408-7242
Mailing Address - Fax:
Practice Address - Street 1:6135 PARK SOUTH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3272
Practice Address - Country:US
Practice Address - Phone:407-408-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1312133V00000X
NCL003989133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered