Provider Demographics
NPI:1720122047
Name:RATLIFF, VIVIAN M (MED, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:M
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:MED, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MEMORIAL DR
Mailing Address - Street 2:FNS DEPARTMENT
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8710
Mailing Address - Country:US
Mailing Address - Phone:910-715-1165
Mailing Address - Fax:910-715-5409
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:FNS DEPARTMENT
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-715-1165
Practice Address - Fax:910-715-5409
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002461133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered