Provider Demographics
NPI:1801593108
Name:MENTEL, CAROLYN ELIZABETH (RD, LD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:MENTEL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ELIZABETH
Other - Last Name:BERNTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:4021 N WESTBROOK CT
Mailing Address - Street 2:
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-3755
Mailing Address - Country:US
Mailing Address - Phone:316-259-2718
Mailing Address - Fax:
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-685-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1511133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered