Provider Demographics
NPI:1053047746
Name:MEME, CAROL ANN (RD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MEME
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N PEACH AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7248
Mailing Address - Country:US
Mailing Address - Phone:559-321-7836
Mailing Address - Fax:559-795-5261
Practice Address - Street 1:755 N PEACH AVE STE A1
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7248
Practice Address - Country:US
Practice Address - Phone:559-321-7836
Practice Address - Fax:559-795-5261
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered