Provider Demographics
NPI:1619325529
Name:REIRIZ, LAURIE (RD)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:REIRIZ
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 1:2823 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1641
Mailing Address - Country:US
Mailing Address - Phone:704-609-1845
Mailing Address - Fax:704-552-0715
Practice Address - Street 1:2823 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1641
Practice Address - Country:US
Practice Address - Phone:704-609-1845
Practice Address - Fax:704-552-0715
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001848133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal