Provider Demographics
NPI:1861570426
Name:DENTON, CAROLYN WARD (MA, LN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:WARD
Last Name:DENTON
Suffix:
Gender:F
Credentials:MA, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 JOPPA AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4939
Mailing Address - Country:US
Mailing Address - Phone:612-850-5468
Mailing Address - Fax:
Practice Address - Street 1:2833 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1319
Practice Address - Country:US
Practice Address - Phone:612-863-3333
Practice Address - Fax:612-863-3107
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN187133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist