Provider Demographics
NPI:1730267063
Name:VENABLE, CARMEN (RD, CD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:VENABLE
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:REID HOSPITAL & HEALTH CARE SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3423
Mailing Address - Fax:765-983-7924
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-983-3423
Practice Address - Fax:765-983-7924
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001333A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN811123OtherCDR# REID HOSPITAL