Provider Demographics
NPI:1457189557
Name:KAROSA, CHRISTINE ANN (RD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:KAROSA
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 1:6205 W BEECH ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-4240
Mailing Address - Country:US
Mailing Address - Phone:570-466-9621
Mailing Address - Fax:
Practice Address - Street 1:6205 W BEECH ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-4240
Practice Address - Country:US
Practice Address - Phone:570-466-9621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61042808133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered