Provider Demographics
NPI:1114000486
Name:HINTZKE, CARRIE (RD)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:HINTZKE
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 1:5TH AVE AND ROOSEVELT RD
Mailing Address - Street 2:MAIL ROUTE 120B
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141
Mailing Address - Country:US
Mailing Address - Phone:708-202-5089
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE AND ROOSEVELT RD
Practice Address - Street 2:MAIL ROUTE 120B
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered