Provider Demographics
NPI:1770721086
Name:MCMAHON, CARRIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:MCMAHON
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 1:800 S.WASHINGTON AVE.,
Mailing Address - Street 2:ST.MARY'S OF MICHIGAN
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2524
Mailing Address - Country:US
Mailing Address - Phone:989-907-8984
Mailing Address - Fax:
Practice Address - Street 1:800 S.WASHINGTON AVE.,
Practice Address - Street 2:ST.MARY'S OF MICHIGAN
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2524
Practice Address - Country:US
Practice Address - Phone:989-907-8984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered