Provider Demographics
NPI:1083730774
Name:VAN MARRELO, CAROLINE MARGARET MARY (MS RD LD)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:MARGARET MARY
Last Name:VAN MARRELO
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 N BOMPART AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1953
Mailing Address - Country:US
Mailing Address - Phone:317-963-0916
Mailing Address - Fax:
Practice Address - Street 1:4580 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1810
Practice Address - Country:US
Practice Address - Phone:314-842-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001879133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered