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Individual

STACY VANBIBBER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, RD, LD

Contact information

Practice address
1457 CAMBRIDGE LAKES DR, MOUNT PLEASANT, SC 29464-7301
(304) 552-4406
Mailing address
1457 CAMBRIDGE LAKES DR, MOUNT PLEASANT, SC 29464-7301
(304) 552-4406

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
675
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
963327
CDR
Enumeration date
01/08/2014
Last updated
01/08/2014
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