Provider Demographics
NPI:1023253069
Name:CARLSON, KATHERINE M (RD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5117 DREW AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2028
Mailing Address - Country:US
Mailing Address - Phone:763-746-9010
Mailing Address - Fax:763-746-9022
Practice Address - Street 1:6200 SHINGLE CREEK PKWY
Practice Address - Street 2:STE 300
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2128
Practice Address - Country:US
Practice Address - Phone:763-746-9010
Practice Address - Fax:763-746-9022
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2780133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal