Provider Demographics
NPI:1114551991
Name:POTTER, CHELSEA EISMANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:EISMANN
Last Name:POTTER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:CHELSEA
Other - Middle Name:BRIANNE
Other - Last Name:EISMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1625 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2228
Mailing Address - Country:US
Mailing Address - Phone:805-801-9692
Mailing Address - Fax:
Practice Address - Street 1:110 N MCCLELLAND ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4419
Practice Address - Country:US
Practice Address - Phone:805-801-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86065917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered