Provider Demographics
NPI:1568175578
Name:CARSON, SAMANTHA CHRISTINA LIOTTA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CHRISTINA LIOTTA
Last Name:CARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 EAGLECREST RD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-8909
Mailing Address - Country:US
Mailing Address - Phone:330-998-2958
Mailing Address - Fax:
Practice Address - Street 1:1373 EAGLECREST RD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-8909
Practice Address - Country:US
Practice Address - Phone:330-998-2958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics