Basic Information
| Provider Information | |||||||||
| NPI: | 1841797131 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARLEE MOELLER DIETITIAN CONSULTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4933 SADLER GLEN CT | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230606171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047146381 | ||||||||
| FaxNumber: | 8046727919 | ||||||||
| Practice Location | |||||||||
| Address1: | 7001 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232943701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047146381 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | MOELLER | ||||||||
| AuthorizedOfficialFirstName: | CARLEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGISTERED DIETITIAN | ||||||||
| AuthorizedOfficialTelephone: | 8057146381 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | R.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1005X | 992809 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal |
No ID Information.