Provider Demographics
NPI:1720096365
Name:SPIELMANN, PATI ANN (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:PATI
Middle Name:ANN
Last Name:SPIELMANN
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:PATI
Other - Middle Name:ANN
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN, CDE
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7390
Mailing Address - Fax:704-384-5669
Practice Address - Street 1:1710 E 4TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3208
Practice Address - Country:US
Practice Address - Phone:704-384-7390
Practice Address - Fax:704-384-5669
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002281133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2994356Medicare ID - Type Unspecified