Provider Demographics
NPI:1528665775
Name:IRACA, DARLENE ANN (RD, LDN)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:ANN
Last Name:IRACA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:ANN
Other - Last Name:IRACA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:183 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE LURE
Mailing Address - State:NC
Mailing Address - Zip Code:28746-9266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10400 MALLARD CREEK RD STE 340
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5203
Practice Address - Country:US
Practice Address - Phone:704-549-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006189133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered