Basic Information
| Provider Information | |||||||||
| NPI: | 1043973266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARMICHAEL | ||||||||
| FirstName: | DEE | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 STATE ST | ||||||||
| Address2: | |||||||||
| City: | LA PORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463503112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743261234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 102 E CULVER RD | ||||||||
| Address2: | |||||||||
| City: | KNOX | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465342216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5747726231 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2021 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 37000836A | IN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.