Provider Demographics
NPI:1659336816
Name:DILL, CARLA J (RD,LD, CDE)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:DILL
Suffix:
Gender:F
Credentials:RD,LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-8537
Mailing Address - Country:US
Mailing Address - Phone:785-825-8221
Mailing Address - Fax:785-825-0644
Practice Address - Street 1:617 E ELM ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-8537
Practice Address - Country:US
Practice Address - Phone:785-825-8221
Practice Address - Fax:785-825-0644
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
498134OtherREGISTERED DIETITIAN
KS130450Medicare ID - Type Unspecified
KSP49585Medicare UPIN