Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 200001236824 | NC |
NPI | 1366414450 |
---|---|
Provider Name | Dr. Lisa Ann Merritt |
First Address | Weddington, NC 28104-9373 |
Second Address | Weddington, NC 28104-9373 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 05/01/2010 |