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Organization

FRUIT OF THE SPIRIT NUTRITION AND WELLNESS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DONNA S GIBSON RD, LDN (REGISTERED DIETITIAN, NUTRITIONIST)
(704) 785-1043
Entity
Organization

Contact information

Practice address
121 GREENWICH RD, SUITE 215, CHARLOTTE, NC 28211-2355
(704) 785-1043
Mailing address
5710 N OAKMONT ST, KANNAPOLIS, NC 28081-6418
(704) 785-1043

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L00325
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1336307479
INDIVIDUAL NPI NUMBER
NC
Enumeration date
12/15/2013
Last updated
02/03/2016
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