Provider Demographics
NPI:1073219853
Name:LEUSNER, CARLY ANNE (MS)
Entity Type:Individual
Prefix:MS
First Name:CARLY
Middle Name:ANNE
Last Name:LEUSNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 TROUBLE ST
Mailing Address - Street 2:
Mailing Address - City:CUMMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01026-9709
Mailing Address - Country:US
Mailing Address - Phone:413-588-6881
Mailing Address - Fax:
Practice Address - Street 1:48 TROUBLE ST
Practice Address - Street 2:
Practice Address - City:CUMMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01026-9709
Practice Address - Country:US
Practice Address - Phone:413-588-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist