Provider Demographics
NPI:1487946935
Name:NEWELL, MICHELLE MINTZ (MS, RD, LDN, CSO)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MINTZ
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MS, RD, LDN, CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-5043
Mailing Address - Fax:704-384-8895
Practice Address - Street 1:125 QUEENS RD STE 330
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3215
Practice Address - Country:US
Practice Address - Phone:704-384-5043
Practice Address - Fax:704-384-8895
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001623133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered