Healthcare Provider Details

I. General information

NPI: 1710766308
Provider Name (Legal Business Name): LAUREN KIEFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 WHIPPOORWILL DR
BATESVILLE IN
47006-8853
US

IV. Provider business mailing address

214 WHIPPOORWILL DR
BATESVILLE IN
47006-8853
US

V. Phone/Fax

Practice location:
  • Phone: 812-212-7467
  • Fax:
Mailing address:
  • Phone: 812-212-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37003368A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: