Provider Demographics
NPI:1619065216
Name:BANNER, CAROLYN SEHLBREDE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SEHLBREDE
Last Name:BANNER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 S HYDE PARK BLVD
Mailing Address - Street 2:APT 3A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4272
Mailing Address - Country:US
Mailing Address - Phone:773-702-4548
Mailing Address - Fax:773-702-3565
Practice Address - Street 1:1531 E HYDE PARK BLVD
Practice Address - Street 2:UNIVERSITY OF CHICAGO HOSPITALS LAKE PARK DIALYSIS UNIT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-3039
Practice Address - Country:US
Practice Address - Phone:773-702-4548
Practice Address - Fax:773-702-3565
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered