Provider Demographics
NPI:1942685599
Name:CARLSON, JULIA A (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-1387
Mailing Address - Country:US
Mailing Address - Phone:252-619-6394
Mailing Address - Fax:
Practice Address - Street 1:470 GREENWAY DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-1387
Practice Address - Country:US
Practice Address - Phone:252-619-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004667133V00000X
OHLD08420133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19HJJOtherBCBS OF NC