Provider Demographics
NPI:1780205898
Name:TEETERS, MORGAN ELIZABETH (MS RDN LD CLC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ELIZABETH
Last Name:TEETERS
Suffix:
Gender:F
Credentials:MS RDN LD CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CAMDEN CIR APT 307
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-0049
Mailing Address - Country:US
Mailing Address - Phone:614-716-9576
Mailing Address - Fax:
Practice Address - Street 1:217 CAMDEN CIR APT 307
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-0049
Practice Address - Country:US
Practice Address - Phone:614-716-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1111133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered