Provider Demographics
NPI:1699727248
Name:CARLSON, ELIZABETH DOROTHY (RD, LD)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DOROTHY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 WESTWINDS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2752
Mailing Address - Country:US
Mailing Address - Phone:319-338-9520
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 6
Practice Address - Street 2:002C
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246
Practice Address - Country:US
Practice Address - Phone:319-338-0581
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00027133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered