Provider Demographics
NPI:1063712099
Name:EICHERT, TARA MICHELLE (RD, CNSC, LDN)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MICHELLE
Last Name:EICHERT
Suffix:
Gender:F
Credentials:RD, CNSC, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-2863
Mailing Address - Country:US
Mailing Address - Phone:910-792-1231
Mailing Address - Fax:910-799-8118
Practice Address - Street 1:720 SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2937
Practice Address - Country:US
Practice Address - Phone:910-660-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered