Provider Demographics
NPI:1861746083
Name:HUSEMAN, CARRIE ELIZABETH (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:HUSEMAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8804 23RD ST NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-6477
Mailing Address - Country:US
Mailing Address - Phone:206-240-4901
Mailing Address - Fax:
Practice Address - Street 1:901 AUBURN WAY N
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4100
Practice Address - Country:US
Practice Address - Phone:206-296-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1069641133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered