Provider Demographics
NPI:1184862864
Name:ROMM, CAITLIN SOTEBEER
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SOTEBEER
Last Name:ROMM
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 1:433 W MEADOWVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-4316
Mailing Address - Country:US
Mailing Address - Phone:336-370-9091
Mailing Address - Fax:336-370-4922
Practice Address - Street 1:1046 E WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6712
Practice Address - Country:US
Practice Address - Phone:336-272-1050
Practice Address - Fax:336-272-0155
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003354133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered