Provider Demographics
NPI:1407851710
Name:NATHAN, CAROLYN JEAN (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JEAN
Last Name:NATHAN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:JEAN
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1820 SERRA WAY
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-5426
Mailing Address - Country:US
Mailing Address - Phone:805-226-2009
Mailing Address - Fax:
Practice Address - Street 1:1820 SERRA WAY
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-5426
Practice Address - Country:US
Practice Address - Phone:805-226-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR388547 (RD)133V00000X
CA0952-0355133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDE001AMedicare ID - Type Unspecified