Provider Demographics
NPI:1548027691
Name:CALDWELL, THERESA LEE (RD,LDN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LEE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LEE
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:61 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-9328
Mailing Address - Country:US
Mailing Address - Phone:717-314-4571
Mailing Address - Fax:
Practice Address - Street 1:61 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-9328
Practice Address - Country:US
Practice Address - Phone:717-314-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002676133V00000X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered