Provider Demographics
NPI:1972931491
Name:TOLLEFSON, CARRIE JAYNE (RD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JAYNE
Last Name:TOLLEFSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:JAYNE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 112TH AVE NE STE 150
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4505
Mailing Address - Country:US
Mailing Address - Phone:425-688-5484
Mailing Address - Fax:425-688-5912
Practice Address - Street 1:1120 112TH AVE NE STE 150
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4505
Practice Address - Country:US
Practice Address - Phone:425-688-5484
Practice Address - Fax:425-688-5912
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000459133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic