Provider Demographics
NPI:1295500015
Name:WHITE, CARLA ELLEN (MS)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ELLEN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 NW VALHALLA DR
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3776
Mailing Address - Country:US
Mailing Address - Phone:406-270-1290
Mailing Address - Fax:
Practice Address - Street 1:1905 NW VALHALLA DR
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3776
Practice Address - Country:US
Practice Address - Phone:406-270-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered