Provider Demographics
NPI:1316223878
Name:CARROTHERS, NANCY B (LD/RD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:CARROTHERS
Suffix:
Gender:F
Credentials:LD/RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6653 APACHE CIR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2403
Mailing Address - Country:US
Mailing Address - Phone:513-833-4551
Mailing Address - Fax:
Practice Address - Street 1:3435 TROY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-4335
Practice Address - Country:US
Practice Address - Phone:937-342-8800
Practice Address - Fax:937-342-8805
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2053133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered