Provider Demographics
NPI:1194336669
Name:DUERST, CARLY (RD)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:DUERST
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:W6068 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:NEW GLARUS
Mailing Address - State:WI
Mailing Address - Zip Code:53574-9735
Mailing Address - Country:US
Mailing Address - Phone:608-512-6398
Mailing Address - Fax:
Practice Address - Street 1:W6068 PIONEER RD
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-9735
Practice Address - Country:US
Practice Address - Phone:608-512-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered