Provider Demographics
NPI:1801040118
Name:SHAFER, CARRIE ANN (RD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:SHAFER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:EK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1143
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1675 DEMPSTER STREET
Practice Address - Street 2:ADVOCATE LUTHERAN GENERAL HOSPITAL-FOOD AND NUTRITION
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-7181
Practice Address - Fax:847-723-2020
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001346133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered