Provider Demographics
NPI:1720017890
Name:SLAGLE, CARLA (RD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:SLAGLE
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 1:511 S WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-2100
Mailing Address - Country:US
Mailing Address - Phone:970-675-5011
Mailing Address - Fax:
Practice Address - Street 1:511 S WHITE AVE
Practice Address - Street 2:
Practice Address - City:RANGELY
Practice Address - State:CO
Practice Address - Zip Code:81648-2100
Practice Address - Country:US
Practice Address - Phone:970-675-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered