Basic Information
| Provider Information | |||||||||
| NPI: | 1861570426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENTON | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | WARD | ||||||||
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| Credential: | MA, LN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3707 JOPPA AVE S | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554164939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128505468 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2833 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128633333 | ||||||||
| FaxNumber: | 6128633107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | N187 | MN | N | Dietary & Nutritional Service Providers | Nutritionist | 133V00000X | N187 | MN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.