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NPI Code Detail

MEDICARE: MEGHANN ELIZABETH WHETSTONE RD

MEDICARE: MEGHANN ELIZABETH WHETSTONE RD
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
1133V00000XRegistered Dietitian37001738AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000633179OTHERINANTHEM
2000000633221OTHERINANTHEM
3000000588430OTHERINANTHEM
400000633315OTHERINANTHEM

General Provider Information

NPI Number : 1063663276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGHANN ELIZABETH WHETSTONE RD
Provider Business Mailing Address
First Line : 1234 E DUPONT RD
Second Line : SUITE 3
City : FORT WAYNE
State : IN
Zip : 46825-1545
Country : US
Telephone Number : 260-373-9700
Fax Number : 260-373-9740
Provider Business Practice Location Address
First Line : 10515 ILLINOIS RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46814-9182
Country : US
Telephone Number : 260-373-9200
Fax Number : 260-373-9219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2008
Last Update Date : 10/16/2009

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Directions to “ MEGHANN ELIZABETH WHETSTONE RD” Practice Location

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