Healthcare Provider Details

I. General information

NPI: 1235478827
Provider Name (Legal Business Name): LESLIE E MUSE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2013
Last Update Date: 02/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14871 HARVEST KNOLL CT
FISHERS IN
46037-8303
US

IV. Provider business mailing address

14871 HARVEST KNOLL CT
FISHERS IN
46037-8303
US

V. Phone/Fax

Practice location:
  • Phone: 317-443-5059
  • Fax: 317-747-7471
Mailing address:
  • Phone: 317-443-5059
  • Fax: 317-747-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: