Provider Demographics
NPI:1972796639
Name:CARRICK, MICHELLE L (RD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:CARRICK
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 1:1800 E. FIR AVE
Mailing Address - Street 2:APT #101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-450-5166
Mailing Address - Fax:559-450-5486
Practice Address - Street 1:1303 EAST HERNDON AVE
Practice Address - Street 2:MAIL STOP #220
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-450-5166
Practice Address - Fax:559-450-5486
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered