Provider Demographics
NPI:1356037188
Name:RYAN, CARLEE DEANN (RD)
Entity type:Individual
Prefix:
First Name:CARLEE
Middle Name:DEANN
Last Name:RYAN
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 1:320 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3914
Mailing Address - Country:US
Mailing Address - Phone:812-583-1374
Mailing Address - Fax:
Practice Address - Street 1:320 EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3914
Practice Address - Country:US
Practice Address - Phone:812-583-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86103287133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered