Provider Demographics
NPI:1417490921
Name:WILL, TERRI (MBA, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:WILL
Suffix:
Gender:F
Credentials:MBA, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 WATTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-6124
Mailing Address - Country:US
Mailing Address - Phone:724-777-1935
Mailing Address - Fax:
Practice Address - Street 1:10130 WATTSBURG RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-6124
Practice Address - Country:US
Practice Address - Phone:724-777-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004213133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered