Basic Information
| Provider Information | |||||||||
| NPI: | 1487964425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INSETTA | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S.R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4755 OGLETOWN-STANTON ROAD | ||||||||
| Address2: | CHRISTIANA CARE HIGH SCHOOL WELLNESS CENTERS | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024773960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2501 EBRIGHT ROAD | ||||||||
| Address2: | CONCORD HIGH SCHOOL WELLNESS CENTER | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198101198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024773960 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2010 | ||||||||
| LastUpdateDate: | 10/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DN-0000370 | DE | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | DN-0000370 | 01 | DE | PROFESSIONAL LICENSE | OTHER |