Provider Demographics
NPI:1467075911
Name:PRICE, THERESA (RD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25624 W ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-5168
Mailing Address - Country:US
Mailing Address - Phone:601-668-8933
Mailing Address - Fax:
Practice Address - Street 1:25624 W ALLEN ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-5168
Practice Address - Country:US
Practice Address - Phone:601-668-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered