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NPI Code Detail

MEDICARE: KRISTINE M CARLSON MS, RD, LDN

MEDICARE: KRISTINE M CARLSON MS, RD, LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133N00000XNutritionistDI60505771WA
2133V00000XRegistered DietitianDI60505771WA

General Provider Information

NPI Number : 1790053411
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINE M CARLSON MS, RD, LDN
Provider Business Mailing Address
First Line : 8301B 5TH AVE NE
Second Line :
City : SEATTLE
State : WA
Zip : 98115-4118
Country : US
Telephone Number : 206-799-7010
Fax Number :
Provider Business Practice Location Address
First Line : 8301B 5TH AVE NE
Second Line :
City : SEATTLE
State : WA
Zip : 98115-4118
Country : US
Telephone Number : 206-799-7010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2011
Last Update Date : 06/11/2019

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