MEDICARE: MRS. CAROLYN JEAN NATHAN RD, CDE

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
1	133V00000X	Registered Dietitian	R388547 (RD)	CA
2	133VN1006X	Metabolic Nutrition Registered Dietitian	0952-0355	CA

General Provider Information

NPI Number	:	1407851710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN JEAN NATHAN RD, CDE

Provider Business Mailing Address
First Line	:	1820 SERRA WAY
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-5426
Country	:	US
Telephone Number	:	805-226-2009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 SERRA WAY
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-5426
Country	:	US
Telephone Number	:	805-226-2009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	10/21/2008

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