Provider Demographics
NPI:1235325218
Name:AMBER, MICHELLE LAND (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LAND
Last Name:AMBER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:KAREN
Other - Last Name:LAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:148 GRANTHAM PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560
Mailing Address - Country:US
Mailing Address - Phone:252-229-6984
Mailing Address - Fax:252-288-4843
Practice Address - Street 1:210 STONEBRIDGE SQUARE
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532
Practice Address - Country:US
Practice Address - Phone:252-229-6984
Practice Address - Fax:252-288-4843
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002363133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered