Provider Demographics
NPI:1568145787
Name:OBOYLE, CARRIE ANN HEPNER (MS RDN LD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN HEPNER
Last Name:OBOYLE
Suffix:
Gender:F
Credentials:MS RDN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 U S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-8909
Mailing Address - Country:US
Mailing Address - Phone:440-821-2960
Mailing Address - Fax:
Practice Address - Street 1:417 U S GRANT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050-8909
Practice Address - Country:US
Practice Address - Phone:440-821-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1005X, 133VN1101X, 133NN1002X, 133VN1201X, 133VN1501X
OH878005133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics