Provider Demographics
NPI:1598009706
Name:DATRES, CARNIE S (RD, LDN)
Entity Type:Individual
Prefix:
First Name:CARNIE
Middle Name:S
Last Name:DATRES
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MARKET ST
Mailing Address - Street 2:THE WILLIAMSPORT BUILDING SUITE 212
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6385
Mailing Address - Country:US
Mailing Address - Phone:570-745-3776
Mailing Address - Fax:570-745-3776
Practice Address - Street 1:460 MARKET ST
Practice Address - Street 2:THE WILLIAMSPORT BUILDING SUITE 212
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6385
Practice Address - Country:US
Practice Address - Phone:570-745-3776
Practice Address - Fax:570-745-3776
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004977133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered