Provider Demographics
NPI:1043234016
Name:HANNERS, CAROLE M (RD,MS, LD)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:M
Last Name:HANNERS
Suffix:
Gender:F
Credentials:RD,MS, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FIELD CREST CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7536
Mailing Address - Country:US
Mailing Address - Phone:859-281-3825
Mailing Address - Fax:859-281-3864
Practice Address - Street 1:1101 VETERANS DR
Practice Address - Street 2:LD120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2235
Practice Address - Country:US
Practice Address - Phone:859-281-3825
Practice Address - Fax:859-281-3864
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered