Individual
STACEY ANN VANDERWEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CSP, LDN
Contact information
Practice address
505 EAST BLVD, SUITE 200, CHARLOTTE, NC 28203-5105
(704) 542-2512
Mailing address
7225 DELOACH CT, CHARLOTTE, NC 28270-9514
(704) 340-1604
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
L002810
NC
Other
Enumeration date
07/09/2008
Last updated
07/09/2008
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