Provider Demographics
NPI:1114275658
Name:BREEDLOVE, TERESA JEAN (MS RD LDN CDE)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:JEAN
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:MS RD LDN CDE
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:ESTES
Other - Last Name:BREEDLOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS RD LDN CDE
Mailing Address - Street 1:777 CASINO DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-9761
Mailing Address - Country:US
Mailing Address - Phone:828-497-8858
Mailing Address - Fax:828-497-8576
Practice Address - Street 1:777 CASINO DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-9761
Practice Address - Country:US
Practice Address - Phone:828-497-8858
Practice Address - Fax:828-497-8576
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000721133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered