Provider Demographics
NPI:1285722132
Name:CARROLL, CHRISTINE CAROZZA (MS RD LD CDE)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:CAROZZA
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3749 WHISTLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44081-9747
Mailing Address - Country:US
Mailing Address - Phone:440-259-5220
Mailing Address - Fax:440-312-5156
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:NORTH CHAMPUS
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-312-8672
Practice Address - Fax:440-312-5156
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD2861133V00000X
OH674960133V00000X
OH09610079163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator