Provider Demographics
NPI:1699198283
Name:PRYOR, DANA HELEAN (RD)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:HELEAN
Last Name:PRYOR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:HELEAN
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2307 RAINBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-8045
Mailing Address - Country:US
Mailing Address - Phone:704-207-6548
Mailing Address - Fax:
Practice Address - Street 1:2307 RAINBROOK DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-8045
Practice Address - Country:US
Practice Address - Phone:704-207-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL002775OtherLICENSE
813392OtherREGISTRATION