Provider Demographics
NPI:1679172878
Name:MCCREA, PRISCILLA L (RD)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:L
Last Name:MCCREA
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:PO BOX 1370
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-1370
Mailing Address - Country:US
Mailing Address - Phone:209-421-0841
Mailing Address - Fax:
Practice Address - Street 1:1000 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-5111
Practice Address - Country:US
Practice Address - Phone:209-421-0841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1037038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered