Healthcare Provider Details

I. General information

NPI: 1831945641
Provider Name (Legal Business Name): TASHA LANE RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14801 MARKET CENTER DR STE 100
CARMEL IN
46033-5518
US

IV. Provider business mailing address

13611 S US ROUTE 31
KOKOMO IN
46901-7766
US

V. Phone/Fax

Practice location:
  • Phone: 765-461-0062
  • Fax:
Mailing address:
  • Phone: 765-461-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37003849A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: