1780054361 NPI number — CAROLYN H NELSON MS, RD, CDN, CDE

NPI Number: 1780054361
Health Care Provider/Practitioner: CAROLYN H NELSON MS, RD, CDN, CDE

NPI Number : 1780054361 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780054361",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NELSON",
    "FirstName": "CAROLYN",
    "MiddleName": "H",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, RD, CDN, CDE",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HENRY",
    "OtherFirstName": "CAROLYN",
    "OtherMiddleName": "G",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS, RD, CDN, CDE",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1201 COLVIN BLVD STE 2A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BUFFALO",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14223-1936",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "716-320-3400",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1201 COLVIN BLVD STE 2A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BUFFALO",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14223-1936",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "716-320-3400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/25/2015",
    "LastUpdateDate": "04/24/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "133V00000X",
        "TaxonomyName": "Registered Dietitian",
        "LicenseNumber": "86032414",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}