Provider Demographics
NPI:1215708144
Name:FERTILITY RD, LLC
Entity type:Organization
Organization Name:FERTILITY RD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FENIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:704-918-5556
Mailing Address - Street 1:715 CONESTOGA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0832
Mailing Address - Country:US
Mailing Address - Phone:704-591-0701
Mailing Address - Fax:877-599-4198
Practice Address - Street 1:715 CONESTOGA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-0832
Practice Address - Country:US
Practice Address - Phone:704-591-0701
Practice Address - Fax:877-599-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty