Healthcare Provider Details

I. General information

NPI: 1033024948
Provider Name (Legal Business Name): PHOEBE BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9726 AMBLESIDE DR UNIT 208
FISHERS IN
46038-9627
US

IV. Provider business mailing address

9726 AMBLESIDE DR UNIT 208
FISHERS IN
46038-9627
US

V. Phone/Fax

Practice location:
  • Phone: 317-490-5954
  • Fax:
Mailing address:
  • Phone: 317-490-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number37004696A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: