Provider Demographics
NPI:1114531944
Name:CARP, ELLEN MARIE (RDN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:CARP
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 N HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1031
Mailing Address - Country:US
Mailing Address - Phone:316-413-5263
Mailing Address - Fax:
Practice Address - Street 1:2728 N HOOVER RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1031
Practice Address - Country:US
Practice Address - Phone:316-413-5263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered