Provider Demographics
NPI:1487318374
Name:CARRIE SCHIMMELPFENNIG RD LLC
Entity type:Organization
Organization Name:CARRIE SCHIMMELPFENNIG RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SCHIMMELPFENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:812-320-5535
Mailing Address - Street 1:1039 OAK CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4535
Mailing Address - Country:US
Mailing Address - Phone:812-320-5535
Mailing Address - Fax:720-282-4629
Practice Address - Street 1:1039 OAK CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80215-4535
Practice Address - Country:US
Practice Address - Phone:812-320-5535
Practice Address - Fax:720-282-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty