Healthcare Provider Details

I. General information

NPI: 1275381808
Provider Name (Legal Business Name): LAURA DEANNE GELATT RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15037 BRIDLEWOOD DR
CARMEL IN
46033-9092
US

IV. Provider business mailing address

15037 BRIDLEWOOD DR
CARMEL IN
46033-9092
US

V. Phone/Fax

Practice location:
  • Phone: 260-705-4820
  • Fax:
Mailing address:
  • Phone: 260-705-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1065180
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: