Basic Information
| Provider Information | |||||||||
| NPI: | 1831735380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5174 ROGERS RD | ||||||||
| Address2: | |||||||||
| City: | HAMBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140753416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165740803 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5470 CAMP RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HAMBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140752756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166462590 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2019 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 009939 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.