Provider Demographics
NPI:1730558248
Name:SUERTH HUDSON, CAROLYN (RDN, LD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SUERTH HUDSON
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8481 PELICAN CT
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-8507
Mailing Address - Country:US
Mailing Address - Phone:612-791-5409
Mailing Address - Fax:
Practice Address - Street 1:8481 PELICAN CT
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-8507
Practice Address - Country:US
Practice Address - Phone:612-791-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2522133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered