Provider Demographics
NPI:1194594705
Name:HART, YVONNE VANESSA (MS, NBHWC)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:VANESSA
Last Name:HART
Suffix:
Gender:F
Credentials:MS, NBHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 SUNNINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2676
Mailing Address - Country:US
Mailing Address - Phone:704-251-9303
Mailing Address - Fax:
Practice Address - Street 1:5300 SUNNINGDALE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2676
Practice Address - Country:US
Practice Address - Phone:704-251-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
NCA-3077747171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education