Individual
LYDIA C WICKENHOEFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD LD
Contact information
Practice address
955 RIBAUT RD, BEAUFORT, SC 29902-5441
(843) 522-5085
Mailing address
955 RIBAUT RD, BEAUFORT, SC 29902-5441
(843) 522-5085
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1406
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
SC
Enumeration date
10/10/2018
Last updated
10/10/2018
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