Provider Demographics
NPI:1780121616
Name:WILSON, KATELYN (RD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:WILSON
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 1:49 OLYPHANT DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4224
Mailing Address - Country:US
Mailing Address - Phone:973-698-3901
Mailing Address - Fax:
Practice Address - Street 1:143A E BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1960
Practice Address - Country:US
Practice Address - Phone:973-698-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered