Provider Demographics
NPI:1093771370
Name:LEE, CAROLE (RD)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 READING CREST AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-1656
Mailing Address - Country:US
Mailing Address - Phone:610-921-2366
Mailing Address - Fax:610-929-5138
Practice Address - Street 1:3200 READING CREST AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-1656
Practice Address - Country:US
Practice Address - Phone:610-921-2366
Practice Address - Fax:610-929-5138
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0003240801OtherBLUE CROSS PROVIDER NUMBE
PA71000285OtherUNITED HEALTHCARE PROV NU
PA71000285OtherUNITED HEALTHCARE PROV NU