JACQUELINE CARLSON (NPI# 1942291935) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942291935 |
| Entity Type | Individual |
| Full Name | JACQUELINE CARLSON |
| Credential | RD CDE |
| Practice Address |
5401 Peach St Erie PA 16509-2601 |
| Mailing Address |
1 Lecom Pl Erie PA 16505-2571 |
| Practice Telephone | 8148682524 |
| Practice Fax Number | 8148682522 |
| Mailing Telephone | 8148682507 |
| Mailing Fax Number | 8148682522 |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2019-04-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133VN1006X |
Dietitian, Registered Specialization: Nutrition, Metabolic |
000806 | NY | Dietary & Nutritional Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | BLUE CROSS | 005261701 | 01 |
| NY | FIDELIS | 051101000071 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 110 Mall Blvd, Lakewood, NY 147502014 | 7167637378 | 7167635671 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174991947 | Jacqueline Carlson | Marriage & Family Therapist | 1301 Pine Ave, Long Beach, CA 90813-3124 | 2015-09-09 |
| Street Address |
5401 PEACH ST |
| City | ERIE |
| State | PA |
| Zip Code | 16509-2601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558362277 | Patrick Francis Leary | Family Medicine | 5401 Peach St, Suite 3400, Erie, PA 16509-2601 | 2005-08-03 |
| 1043570443 | Medical Associates of Erie Inc. | Non-Pharmacy Dispensing Site | 5401 Peach St, 3rd Floor, Erie, PA 16509-2601 | 2012-05-21 |
| 1962779447 | Marguerite Evanoff-jurkovic | Neuromusculoskeletal Medicine & OMM | 5401 Peach St, Suite 3500, Erie, PA 16509-2601 | 2011-11-28 |
| 1174844310 | Christopher Rial | Family Medicine | 5401 Peach St, Suite 3400, Erie, PA 16509-2601 | 2010-06-22 |
| 1144459728 | Jason E Lee | Podiatrist | 5401 Peach St, Suite 3600, Erie, PA 16509-2601 | 2009-07-05 |
| 1063677524 | Garrett Clark | Internal Medicine | 5401 Peach St, Suite 3500, Erie, PA 16509-2601 | 2008-07-24 |
| 1326242785 | Jan T Hendryx | Neuromusculoskeletal Medicine & OMM | 5401 Peach St, Suite 3500, Erie, PA 16509-2601 | 2007-06-12 |
| 1568583326 | Blake Anne-elizabeth Hoppe | Psychiatry & Neurology | 5401 Peach St, Suite 3600, Erie, PA 16509-2601 | 2007-04-02 |
| 1861539504 | Yvonne Theresa Hoogland | Internal Medicine | 5401 Peach St, Suite 3400, Erie, PA 16509-2601 | 2007-01-31 |
| 1285703058 | Ruel L Taylor | Urology | 5401 Peach St, Suite 3600, Erie, PA 16509-2601 | 2006-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598243073 | Austin Dudenhoefer | Physical Therapist | 8270 Peach St Ste 400, Erie, PA 16509 | 2018-08-06 |
| 1770092884 | Latasha Marie Phillips | Social Worker | 5100 Peach Street, Erie, PA 16509 | 2017-09-21 |
| 1932621307 | Mitchell Meagher | Internal Medicine | 5515 Peach St., Attn: Medical Education, Erie, PA 16509 | 2017-07-07 |
| 1760903702 | Tricia Lee Cubitt | Social Worker | 4756 Springview Drive, Apartment 310, Erie, PA 16509 | 2017-06-29 |
| 1790191617 | Ashley Russell | Physical Therapy Assistant | 1267 South Hill Road, Erie, PA 16509 | 2014-07-11 |
| 1295084085 | Michael David Mccafferty | Internal Medicine | 5332 Rome Court Drive, 301, Erie, PA 16509 | 2012-09-07 |
| 1427303619 | Michelle Mary Dillaene Tobin | Social Worker | 828 W. Gore Road, Erie, PA 16509 | 2012-07-13 |
| 1962761411 | Moshood B Martins | Dentist | 7040 Peach Street, Erie, PA 16509 | 2012-05-03 |
| 1770854549 | Peach Street Dental & Dentures, PC. | Dentist | 7040 Peach St, Erie, PA 16509 | 2012-01-25 |
| 1881989515 | Richard R Sambuchino | Dentist | 4944 Peach Street, Erie, PA 16509 | 2011-06-10 |
| Find all providers in zip 16509 | ||||
| Taxonomy Code | 133VN1006X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Metabolic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588029276 | Saint Vincent Medical Education and Research Institute | Dietitian, Registered | 145 W 23rd St, Suite 302a, Erie, PA 16502-2858 | 2015-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720640378 | Sylvia Pisarski Onusic | Dietitian, Registered | 1602 Kent St, Portage, PA 15946-2113 | 2019-07-03 |
| 1568923274 | Sarahricenutrition, LLC | Dietitian, Registered | 20 Dogwood Hill Ln, Chadds Ford, PA 19317-9106 | 2019-03-26 |
| 1346741220 | Shannon Elizabeth Schwartz | Dietitian, Registered | 3056 Princeton Ave, Philadelphia, PA 19149-1412 | 2018-02-26 |
| 1528423803 | Annabelle Mccoy | Dietitian, Registered | 3824 Northern Pike Ste 350, Monroeville, PA 15146-2171 | 2015-12-30 |
| 1912382631 | Jessica Hamilton | Dietitian, Registered | 155 Towne Centre Avenue, Wexford, PA 15090 | 2015-07-23 |
| 1497166524 | Megan Klucinec | Dietitian, Registered | 556 Pittsburgh Mills Circle, Destination Wellness, Tarentum, PA 15084 | 2014-05-12 |
| 1538580717 | Lisa P Rider | Dietitian, Registered | 725 Bradford Ter, West Chester, PA 19382-1818 | 2013-12-14 |
| 1467710376 | Tia Nicole Wade | Dietitian, Registered | 8901 Route 30, North Huntingdon, PA 15642-2704 | 2012-04-27 |
| 1922307040 | Lisa Ann Matt | Dietitian, Registered | 200 Tarentum Bridge Road, New Kensington, PA 15068 | 2011-03-16 |
| 1598063570 | Lauren Green | Dietitian, Registered | 328 E Jefferson St, Butler, PA 16001-6009 | 2011-03-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.