Provider Demographics
NPI:1841797131
Name:CARLEE MOELLER DIETITIAN CONSULTANT
Entity Type:Organization
Organization Name:CARLEE MOELLER DIETITIAN CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:805-714-6381
Mailing Address - Street 1:4933 SADLER GLEN CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6171
Mailing Address - Country:US
Mailing Address - Phone:804-714-6381
Mailing Address - Fax:804-672-7919
Practice Address - Street 1:7001 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-3701
Practice Address - Country:US
Practice Address - Phone:804-714-6381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA992809133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty