Provider Demographics
NPI:1558891341
Name:LANCE, CAITLYN MARIE (RD)
Entity Type:Individual
Prefix:MS
First Name:CAITLYN
Middle Name:MARIE
Last Name:LANCE
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 1:29 HOYT RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9418
Mailing Address - Country:US
Mailing Address - Phone:423-280-9228
Mailing Address - Fax:
Practice Address - Street 1:29 HOYT RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9418
Practice Address - Country:US
Practice Address - Phone:423-280-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86061421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered