Provider Demographics
NPI:1710470943
Name:SCHAFER, JANE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SCHAFER
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 1:1590 NUNNELLY LN APT 202
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-0109
Mailing Address - Country:US
Mailing Address - Phone:301-676-6358
Mailing Address - Fax:
Practice Address - Street 1:1315 MATTHEWS MINT HILL RD STE 2B
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2401
Practice Address - Country:US
Practice Address - Phone:704-246-6808
Practice Address - Fax:704-246-6808
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered