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Individual
JENNA RAE CARLSON
Active
Individual
JENNA RAE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDMN
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86027129
CDR
—
Enumeration date
10/05/2016
Last updated
10/05/2016
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