Provider Demographics
NPI:1477947224
Name:HERMECZ, RACHEL ELIZABETH (MS, RDN, LD)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:HERMECZ
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8115
Mailing Address - Country:US
Mailing Address - Phone:404-374-3437
Mailing Address - Fax:
Practice Address - Street 1:302 POMONA DR
Practice Address - Street 2:STE. L
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1663
Practice Address - Country:US
Practice Address - Phone:404-374-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004378133V00000X
GALD004208133V00000X
SC1331133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered