Provider Demographics
NPI:1871787705
Name:MCVICKER, MONICA (RD)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:MCVICKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SHAWN RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-8939
Mailing Address - Country:US
Mailing Address - Phone:910-671-3274
Mailing Address - Fax:910-671-3484
Practice Address - Street 1:460 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-9494
Practice Address - Country:US
Practice Address - Phone:910-671-3274
Practice Address - Fax:910-671-3484
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC855477133V00000X
NCL001881133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist