Provider Demographics
NPI:1154127090
Name:CARLSON, PATRICIA KAY ALEA (RDN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAY ALEA
Last Name:CARLSON
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11629 SCHRAM ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1317
Mailing Address - Country:US
Mailing Address - Phone:586-625-2415
Mailing Address - Fax:
Practice Address - Street 1:11629 SCHRAM ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1317
Practice Address - Country:US
Practice Address - Phone:586-625-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered