Basic Information
Provider Information
NPI: 1003147943
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TURNER
FirstName: CAROL
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: PHD, RD, LD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 16199
Address2:  
City: LAS CRUCES
State: NM
PostalCode: 880046199
CountryCode: US
TelephoneNumber: 5755415367
FaxNumber: 5755321928
Practice Location
Address1: 3012 LOOKOUT RIDGE DR
Address2:  
City: LAS CRUCES
State: NM
PostalCode: 880111640
CountryCode: US
TelephoneNumber: 5755415367
FaxNumber: 5755321928
Other Information
ProviderEnumerationDate: 01/15/2010
LastUpdateDate: 01/15/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000X467NMY Dietary & Nutritional Service ProvidersDietitian, Registered 
133V00000X655464NMN Dietary & Nutritional Service ProvidersDietitian, Registered 

ID Information
IDTypeStateIssuerDescription
000D397205NM MEDICAID


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