Provider Demographics
NPI:1578380499
Name:ROBINSON, MORGAN LANE
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LANE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4491 ODELL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7476
Mailing Address - Country:US
Mailing Address - Phone:704-900-9260
Mailing Address - Fax:
Practice Address - Street 1:4491 ODELL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7476
Practice Address - Country:US
Practice Address - Phone:704-900-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL008158133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered