Provider Demographics
NPI:1538380134
Name:REDDISH, MESINA (RD,LDN)
Entity type:Individual
Prefix:
First Name:MESINA
Middle Name:
Last Name:REDDISH
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PINE STREET
Mailing Address - Street 2:PO BOX 394
Mailing Address - City:RICH SQUARE
Mailing Address - State:NC
Mailing Address - Zip Code:27869
Mailing Address - Country:US
Mailing Address - Phone:252-539-2966
Mailing Address - Fax:
Practice Address - Street 1:116 PINE STREET
Practice Address - Street 2:
Practice Address - City:RICH SQUARE
Practice Address - State:NC
Practice Address - Zip Code:27869
Practice Address - Country:US
Practice Address - Phone:252-539-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002209133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2994062Medicare ID - Type Unspecified