Provider Demographics
NPI:1669820668
Name:GERBELING, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:GERBELING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:HOSTETLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LMNT
Mailing Address - Street 1:5355 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1277
Mailing Address - Country:US
Mailing Address - Phone:402-742-8500
Mailing Address - Fax:402-328-9210
Practice Address - Street 1:5355 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1277
Practice Address - Country:US
Practice Address - Phone:402-742-8500
Practice Address - Fax:402-328-9210
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE584133V00000X
NE864307133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
864307OtherCOMISSION OF DIETETIC REGISTRATION
NE584OtherSTATE OF NEBRAKSA