Individual
ILISSA MARIE PALMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Contact information
Practice address
4102 PROVIDENCE RD APT C, CHARLOTTE, NC 28211-4456
(585) 354-5449
Mailing address
4102 PROVIDENCE RD APT C, CHARLOTTE, NC 28211-4456
(585) 354-5449
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L004231
NC
Other
Enumeration date
11/25/2013
Last updated
11/25/2013
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