Provider Demographics
NPI:1942647680
Name:CROSBIE, CASEY (RD, CEDS-S)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CROSBIE
Suffix:
Gender:F
Credentials:RD, CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 B ST STE 5
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4678
Mailing Address - Country:US
Mailing Address - Phone:408-444-5347
Mailing Address - Fax:
Practice Address - Street 1:140 B ST STE 5
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4678
Practice Address - Country:US
Practice Address - Phone:408-444-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980937133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered