Provider Demographics
NPI:1700218435
Name:MULCHAN, REBEKAH LEE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LEE
Last Name:MULCHAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BLYTHE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5865
Mailing Address - Country:US
Mailing Address - Phone:704-381-8025
Mailing Address - Fax:
Practice Address - Street 1:1001 BLYTHE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5865
Practice Address - Country:US
Practice Address - Phone:704-381-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004081133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered