Provider Demographics
NPI:1982321105
Name:KOFFEL, ERICKA LINDSAY (RD, LDN, CHWC)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:LINDSAY
Last Name:KOFFEL
Suffix:
Gender:F
Credentials:RD, LDN, CHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BALLY
Mailing Address - State:PA
Mailing Address - Zip Code:19503-9684
Mailing Address - Country:US
Mailing Address - Phone:609-903-1866
Mailing Address - Fax:
Practice Address - Street 1:401 DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:BALLY
Practice Address - State:PA
Practice Address - Zip Code:19503-9684
Practice Address - Country:US
Practice Address - Phone:609-903-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007475133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered