Provider Demographics
NPI:1174411599
Name:FELDER, TERESA GWENDOLYN
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:GWENDOLYN
Last Name:FELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2736
Mailing Address - Country:US
Mailing Address - Phone:402-516-5036
Mailing Address - Fax:
Practice Address - Street 1:3334 SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2736
Practice Address - Country:US
Practice Address - Phone:402-516-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology