Individual
STACIE WHEATLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, RD, LD
Contact information
Practice address
30 W AVONDALE DR, GREENVILLE, SC 29609-4751
(864) 907-3636
Mailing address
30 W AVONDALE DR, GREENVILLE, SC 29609-4751
(864) 907-3636
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
114
SC
Other
Enumeration date
09/14/2023
Last updated
03/12/2024
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