Provider Demographics
NPI:1356578330
Name:STANNARD, CARRIE J (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:J
Last Name:STANNARD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W LORAIN ST
Mailing Address - Street 2:FOOD SERVICE
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-1026
Mailing Address - Country:US
Mailing Address - Phone:440-775-1211
Mailing Address - Fax:
Practice Address - Street 1:200 W LORAIN ST
Practice Address - Street 2:FOOD SERVICE
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1026
Practice Address - Country:US
Practice Address - Phone:440-775-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5373133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered