Healthcare Provider Details

I. General information

NPI: 1124873542
Provider Name (Legal Business Name): MADELYN CARNAHAN MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 INVERNESS DR
DEFIANCE OH
43512-8549
US

IV. Provider business mailing address

724 INVERNESS DR
DEFIANCE OH
43512-8549
US

V. Phone/Fax

Practice location:
  • Phone: 419-980-9813
  • Fax:
Mailing address:
  • Phone: 419-980-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37003994A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.10548
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: