Provider Demographics
NPI:1164621520
Name:GALLANT, MONICA REBECCA (RD)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:REBECCA
Last Name:GALLANT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 MERRYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6711
Mailing Address - Country:US
Mailing Address - Phone:704-554-9447
Mailing Address - Fax:704-541-3475
Practice Address - Street 1:10620 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8472
Practice Address - Country:US
Practice Address - Phone:704-543-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC896321133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered