Provider Demographics
NPI:1699965632
Name:CARLSON, NATALIE J (RD)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-286-0800
Mailing Address - Fax:314-286-0855
Practice Address - Street 1:4205 FOREST PARK AVE
Practice Address - Street 2:DIV IM NEPHROLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2810
Practice Address - Country:US
Practice Address - Phone:314-286-0800
Practice Address - Fax:314-286-0855
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013029756133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered