Provider Demographics
NPI:1639656796
Name:HAVERLAND, ADRIENNE R (RD, LDN)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:R
Last Name:HAVERLAND
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 1:6 TARA AVE
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4119
Mailing Address - Country:US
Mailing Address - Phone:937-477-9074
Mailing Address - Fax:
Practice Address - Street 1:6 TARA AVE
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-4119
Practice Address - Country:US
Practice Address - Phone:937-477-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC964133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty