Provider Demographics
NPI:1932976891
Name:CARRIER, LESLEY ANNE (RD)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANNE
Last Name:CARRIER
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 1:418 PARK PLACE DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6647
Mailing Address - Country:US
Mailing Address - Phone:707-738-1604
Mailing Address - Fax:
Practice Address - Street 1:418 PARK PLACE DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6647
Practice Address - Country:US
Practice Address - Phone:707-738-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
803634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered