Provider Demographics
NPI:1336787084
Name:KRASUSKI, CANDICE (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:KRASUSKI
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 LAKE PARK DR APT 304
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-5542
Mailing Address - Country:US
Mailing Address - Phone:910-547-0158
Mailing Address - Fax:
Practice Address - Street 1:101 E W T HARRIS BLVD STE 2122B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-863-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered