Provider Demographics
NPI:1447012455
Name:DEMARZO, CALEIGH
Entity type:Individual
Prefix:
First Name:CALEIGH
Middle Name:
Last Name:DEMARZO
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 1:358 MONTGOMERY AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:TN
Mailing Address - Zip Code:37645-3593
Mailing Address - Country:US
Mailing Address - Phone:423-963-0346
Mailing Address - Fax:
Practice Address - Street 1:358 MONTGOMERY AVE APT 5
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:TN
Practice Address - Zip Code:37645-3593
Practice Address - Country:US
Practice Address - Phone:423-963-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000004319133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered