Healthcare Provider Details

I. General information

NPI: 1386701456
Provider Name (Legal Business Name): TRINA EASTIN M.A., R.D.,C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11979 SLOANE MUSE
FISHERS IN
46037-4158
US

IV. Provider business mailing address

PO BOX 456
FISHERS IN
46038-0456
US

V. Phone/Fax

Practice location:
  • Phone: 317-847-4225
  • Fax:
Mailing address:
  • Phone: 317-847-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37000333A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: