Healthcare Provider Details

I. General information

NPI: 1578140190
Provider Name (Legal Business Name): OLIVIA FLEDDERMAN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S DEPOT ST
BATESVILLE IN
47006-1474
US

IV. Provider business mailing address

16034 SAINT MARYS RD
BROOKVILLE IN
47012-8834
US

V. Phone/Fax

Practice location:
  • Phone: 765-265-8075
  • Fax:
Mailing address:
  • Phone: 765-265-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86109773
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: