Provider Demographics
NPI:1356762033
Name:ANDERSON, CAROLYN (RD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:REINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 14909
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-0909
Mailing Address - Country:US
Mailing Address - Phone:612-871-1145
Mailing Address - Fax:612-870-5491
Practice Address - Street 1:2200 UNIVERSITY AVE W STE 120
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1844
Practice Address - Country:US
Practice Address - Phone:612-870-5557
Practice Address - Fax:612-870-5491
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3178133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3178OtherMN BORAD OF DIETETICS AND NUTRITION PRACTICE