Provider Demographics
NPI:1053624668
Name:CAUDLE, NANCY J (RD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:CAUDLE
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 1:6021 COUNTRY CT
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-9401
Mailing Address - Country:US
Mailing Address - Phone:209-969-0183
Mailing Address - Fax:209-358-0393
Practice Address - Street 1:6021 COUNTRY CT
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-9401
Practice Address - Country:US
Practice Address - Phone:209-969-0183
Practice Address - Fax:209-358-0393
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered