Individual
LISA ANNE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
1224 W ROOSEVELT BLVD, MONROE, NC 28110-2820
(704) 296-4891
Mailing address
10624 CORONET CT, HARRISBURG, NC 28075-8610
(919) 440-0424
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
L004760
NC
133V00000X
Registered Dietitian
Primary
L004760
NC
Other
Enumeration date
08/23/2017
Last updated
08/23/2017
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