Provider Demographics
NPI:1992337307
Name:LEWIS, CAITLIN WHITE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:WHITE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BLUE TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9596
Mailing Address - Country:US
Mailing Address - Phone:757-339-3875
Mailing Address - Fax:
Practice Address - Street 1:30 BLUE TRAIL CT
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9596
Practice Address - Country:US
Practice Address - Phone:757-339-3875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1162OtherSOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING & REGULATION