Provider Demographics
NPI:1124393111
Name:CARSON, KLARA LEE (ND)
Entity Type:Individual
Prefix:DR
First Name:KLARA
Middle Name:LEE
Last Name:CARSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5000 E HENRIETTA RD APT D11
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-8945
Mailing Address - Country:US
Mailing Address - Phone:585-210-9355
Mailing Address - Fax:585-413-0489
Practice Address - Street 1:3450 WINTON PL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2805
Practice Address - Country:US
Practice Address - Phone:585-210-9355
Practice Address - Fax:585-413-0489
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0083260175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath