Provider Demographics
NPI:1467413807
Name:CARLISLE, NANCY JEAN (MS, RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JEAN
Other - Last Name:SCHNACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD, CDE
Mailing Address - Street 1:500 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2689
Mailing Address - Country:US
Mailing Address - Phone:319-339-2678
Mailing Address - Fax:319-688-7189
Practice Address - Street 1:500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2689
Practice Address - Country:US
Practice Address - Phone:319-339-2678
Practice Address - Fax:319-688-7189
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17356Medicare ID - Type Unspecified