1487051504 NPI number — KARA CARR RD, LDN

Table of content: KARA CARR RD, LDN (NPI 1487051504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487051504 NPI number — KARA CARR RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
KARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487051504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 MADISON ST
Provider Second Line Business Mailing Address:
FOOD AND NUTRITION DEPARTMENT
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435-8200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-725-7133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 MADISON ST
Provider Second Line Business Practice Location Address:
FOOD AND NUTRITION DEPARTMENT
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435-8200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-725-7133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)