Provider Demographics
NPI:1093284358
Name:CLUTTER, CARMEN MARIE (MS, RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:MARIE
Last Name:CLUTTER
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:MARIE
Other - Last Name:CANESTRARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1537 WEISKOPF DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-7077
Mailing Address - Country:US
Mailing Address - Phone:614-949-2003
Mailing Address - Fax:
Practice Address - Street 1:660 ACKERMAN RD FL 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-4500
Practice Address - Country:US
Practice Address - Phone:614-293-2010
Practice Address - Fax:614-293-9908
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1067299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered