Provider Demographics
NPI:1922156322
Name:GREEN, ERIKA MARIE (RD,LDN)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:MARIE
Other - Last Name:SPANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9617 COMMONS EAST DR
Mailing Address - Street 2:#D
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1715
Mailing Address - Country:US
Mailing Address - Phone:980-230-9370
Mailing Address - Fax:
Practice Address - Street 1:2536A PLANTATION CENTER DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5298
Practice Address - Country:US
Practice Address - Phone:980-230-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered