Provider Demographics
NPI:1124588611
Name:CREAMER, THERESA (PA-C, RD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CREAMER
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4227
Mailing Address - Country:US
Mailing Address - Phone:860-493-1950
Mailing Address - Fax:860-493-1961
Practice Address - Street 1:988 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4227
Practice Address - Country:US
Practice Address - Phone:860-493-1950
Practice Address - Fax:860-493-1961
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59.001264133V00000X
CT5707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered