Provider Demographics
NPI:1487892907
Name:NAKLES, CAROL L
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:L
Last Name:NAKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BRYANT DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4626
Mailing Address - Country:US
Mailing Address - Phone:412-371-5768
Mailing Address - Fax:
Practice Address - Street 1:101 BRADFORD RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6909
Practice Address - Country:US
Practice Address - Phone:412-779-1280
Practice Address - Fax:412-366-8965
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001099133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist