Provider Demographics
NPI:1407618523
Name:MCINTYRE, CHARLOTTE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 E DUNBAR LN APT 311
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3186
Mailing Address - Country:US
Mailing Address - Phone:307-620-9827
Mailing Address - Fax:
Practice Address - Street 1:88 E DUNBAR LN APT 311
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3186
Practice Address - Country:US
Practice Address - Phone:307-620-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports DieteticsGroup - Multi-Specialty