Provider Demographics
NPI:1902671589
Name:METABOLIC RESET CLINIC
Entity Type:Organization
Organization Name:METABOLIC RESET CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, AGNP-C
Authorized Official - Phone:980-430-3130
Mailing Address - Street 1:3141 AMITY CT STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5745
Mailing Address - Country:US
Mailing Address - Phone:844-699-6733
Mailing Address - Fax:704-946-5205
Practice Address - Street 1:3141 AMITY CT STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5745
Practice Address - Country:US
Practice Address - Phone:804-303-1309
Practice Address - Fax:980-245-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty