Provider Demographics
NPI:1467713446
Name:CRESS, EILEEN M (MS,RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:M
Last Name:CRESS
Suffix:
Gender:F
Credentials:MS,RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 UNIVERSITY PKWY
Mailing Address - Street 2:BOX 70403
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4071
Mailing Address - Fax:423-439-4060
Practice Address - Street 1:2151 CENTURY LANE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-439-4071
Practice Address - Fax:423-439-4060
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000817133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLDN817OtherST LICENSE