Provider Demographics
NPI:1972870137
Name:NEUBERT, CARLY (NC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:NEUBERT
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8985 DOUBLE DIAMOND PKWY STE B8
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4879
Mailing Address - Country:US
Mailing Address - Phone:805-354-8061
Mailing Address - Fax:
Practice Address - Street 1:8985 DOUBLE DIAMOND PKWY # B8NA
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-6005
Practice Address - Country:US
Practice Address - Phone:805-354-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist