Provider Demographics
NPI:1922338979
Name:PEASLEE, CAROLYN (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:PEASLEE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 CAMDEN LAKE ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-3800
Mailing Address - Country:US
Mailing Address - Phone:724-272-0716
Mailing Address - Fax:
Practice Address - Street 1:6020 CAMDEN LAKE ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-3800
Practice Address - Country:US
Practice Address - Phone:724-272-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80810133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered