Individual
MRS. CAROL LYNN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DTR
Contact information
Practice address
1603 E FOURTH PLAIN BLVD, VANCOUVER, WA 98661-3753
(360) 696-4061
Mailing address
11303 NE MEAD RD, VANCOUVER, WA 98682-9591
(360) 254-6435
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
—
—
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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