Provider Demographics
NPI:1376372771
Name:MCLEAN, CRYSTAL A (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SIX FORKS ROAD
Mailing Address - Street 2:STE 107 #1055
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4468
Mailing Address - Country:US
Mailing Address - Phone:919-594-4848
Mailing Address - Fax:
Practice Address - Street 1:5306 SIX FORKS RD STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4468
Practice Address - Country:US
Practice Address - Phone:919-594-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL008070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty