Provider Demographics
NPI:1881845014
Name:CALDWELL, DEBORAH A (BS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18620 WEXFORD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1858
Mailing Address - Country:US
Mailing Address - Phone:313-892-2654
Mailing Address - Fax:313-892-2654
Practice Address - Street 1:13340 E WARREN
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215
Practice Address - Country:US
Practice Address - Phone:313-822-6940
Practice Address - Fax:313-822-0176
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist