Provider Demographics
NPI:1104281443
Name:BEIDEMAN, TERRI LEI
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LEI
Last Name:BEIDEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NANTUCKET RD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-5105
Mailing Address - Country:US
Mailing Address - Phone:609-891-8872
Mailing Address - Fax:
Practice Address - Street 1:215 NANTUCKET RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-5105
Practice Address - Country:US
Practice Address - Phone:609-891-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist