Provider Demographics
NPI:1326261413
Name:LICHTNER, HEIDI HANSON (RD)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:HANSON
Last Name:LICHTNER
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 1:8839 BLUESTONE BAY CT
Mailing Address - Street 2:
Mailing Address - City:SHERRILLS FORD
Mailing Address - State:NC
Mailing Address - Zip Code:28673-3005
Mailing Address - Country:US
Mailing Address - Phone:704-609-6196
Mailing Address - Fax:
Practice Address - Street 1:8839 BLUESTONE BAY CT
Practice Address - Street 2:
Practice Address - City:SHERRILLS FORD
Practice Address - State:NC
Practice Address - Zip Code:28673-3005
Practice Address - Country:US
Practice Address - Phone:704-609-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001626133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142U0OtherBCBSNC PROVIDER NUMBER
NC2993485AMedicare PIN