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NPI Code Detail

MEDICARE: CAROLYN WARD DENTON MA, LN

MEDICARE: CAROLYN WARD DENTON MA, LN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133N00000XNutritionistN187MN
2133V00000XRegistered DietitianN187MN

General Provider Information

NPI Number : 1861570426
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN WARD DENTON MA, LN
Provider Business Mailing Address
First Line : 3707 JOPPA AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-4939
Country : US
Telephone Number : 612-850-5468
Fax Number :
Provider Business Practice Location Address
First Line : 2833 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1319
Country : US
Telephone Number : 612-863-3333
Fax Number : 612-863-3107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 03/17/2018

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