Provider Demographics
NPI:1689756645
Name:BURNS, CAROLYN SUE (RD)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:SUE
Last Name:BURNS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1227
Mailing Address - Country:US
Mailing Address - Phone:812-426-9372
Mailing Address - Fax:812-426-9778
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9372
Practice Address - Fax:812-426-9778
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001038A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000560815OtherANTHEM
IN849820UUUMedicare PIN
P00470129Medicare PIN
IN257900AAAAMedicare PIN