Basic Information
| Provider Information | |||||||||
| NPI: | 1326244203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETER | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 HUNTERS RUN DR | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294647708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433644372 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 RICHLAND MEDICAL PARK DR | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034347990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 877167 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.