Provider Demographics
NPI:1073973434
Name:KLUTTZ, CAROLINE RAE (MS, RDN, LDN)
Entity Type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:RAE
Last Name:KLUTTZ
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 ELIZABETH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2547
Mailing Address - Country:US
Mailing Address - Phone:704-910-1402
Mailing Address - Fax:704-910-1506
Practice Address - Street 1:1523 ELIZABETH AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2547
Practice Address - Country:US
Practice Address - Phone:704-910-1402
Practice Address - Fax:704-910-1506
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-28
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004846133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered