Provider Demographics
NPI:1841218047
Name:PESTER-PHILLIPS, COLETTE NICHOLE (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:NICHOLE
Last Name:PESTER-PHILLIPS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:COLETTE
Other - Middle Name:NICHOLE
Other - Last Name:PESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:500 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4104
Mailing Address - Country:US
Mailing Address - Phone:610-241-2492
Mailing Address - Fax:
Practice Address - Street 1:825 OLD LANCASTER RD STE 360
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3238
Practice Address - Country:US
Practice Address - Phone:484-380-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA003476133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered