Provider Demographics
NPI:1023773553
Name:CAPPER, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CAPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6173
Mailing Address - Country:US
Mailing Address - Phone:309-863-0590
Mailing Address - Fax:
Practice Address - Street 1:1900 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6173
Practice Address - Country:US
Practice Address - Phone:309-863-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133N00000XDietary & Nutritional Service ProvidersNutritionist