Healthcare Provider Details

I. General information

NPI: 1962759993
Provider Name (Legal Business Name): MRS. NOELLE L CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 LANTERN RD STE 235
FISHERS IN
46038-3106
US

IV. Provider business mailing address

11650 LANTERN RD STE 235
FISHERS IN
46038-3106
US

V. Phone/Fax

Practice location:
  • Phone: 317-576-8410
  • Fax: 888-654-4116
Mailing address:
  • Phone: 317-576-8410
  • Fax: 888-654-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37002214A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: