Provider Demographics
NPI:1871263863
Name:LESLIE VAN HORN NUTRITION LLC
Entity Type:Organization
Organization Name:LESLIE VAN HORN NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:VAN HORN
Authorized Official - Suffix:
Authorized Official - Credentials:DCN, RDN, LDN, FAND
Authorized Official - Phone:980-292-1305
Mailing Address - Street 1:7722 QUAIL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6928
Mailing Address - Country:US
Mailing Address - Phone:843-421-0134
Mailing Address - Fax:
Practice Address - Street 1:7722 QUAIL PARK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6928
Practice Address - Country:US
Practice Address - Phone:980-292-1305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty