Provider Demographics
NPI:1477996551
Name:LAND, CAROL (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LAND
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 1:2411 WAXHAW MARVIN RD
Mailing Address - Street 2:
Mailing Address - City:MARVIN
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7526
Mailing Address - Country:US
Mailing Address - Phone:704-843-4306
Mailing Address - Fax:
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3174
Practice Address - Country:US
Practice Address - Phone:704-544-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000826133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered