Provider Demographics
NPI:1518186931
Name:CURTIS, CAROL SUE (RD,CD)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:SUE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:RD,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2528
Mailing Address - Country:US
Mailing Address - Phone:574-293-2220
Mailing Address - Fax:574-647-6831
Practice Address - Street 1:MEMORIAL HOSPITAL
Practice Address - Street 2:615 NORTH MICHIGAN STREET
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-647-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000853A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN941030XXMedicare ID - Type UnspecifiedDIABETIC & RENAL