Provider Demographics
NPI:1912210097
Name:BOYES, CARLA B (RD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:B
Last Name:BOYES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S MERRIMAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5539
Mailing Address - Country:US
Mailing Address - Phone:734-727-1061
Mailing Address - Fax:734-727-1035
Practice Address - Street 1:2001 S MERRIMAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5539
Practice Address - Country:US
Practice Address - Phone:734-727-1061
Practice Address - Fax:734-727-1035
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
307545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered