Provider Demographics
NPI:1124275771
Name:SWITZER, CARISSA ELIDA (MS, RD, CD, CNSC)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:ELIDA
Last Name:SWITZER
Suffix:
Gender:F
Credentials:MS, RD, CD, CNSC
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:E
Other - Last Name:SUNDSMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:2811 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3761
Mailing Address - Country:US
Mailing Address - Phone:509-575-1174
Mailing Address - Fax:509-249-5265
Practice Address - Street 1:302 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3521
Practice Address - Country:US
Practice Address - Phone:509-575-1174
Practice Address - Fax:509-249-5265
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA998600133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60211282OtherDIETITIAN CERTIFICATION
WA998600OtherCERTIFICATION OF DIETETIC REGISTRATION