Healthcare Provider Details

I. General information

NPI: 1174312425
Provider Name (Legal Business Name): TANDEM NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2025
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 MIRAMAR CT
INDIANAPOLIS IN
46250-3415
US

IV. Provider business mailing address

6505 MIRAMAR CT
INDIANAPOLIS IN
46250-3415
US

V. Phone/Fax

Practice location:
  • Phone: 225-454-4435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: GARRETT SERD
Title or Position: CEO
Credential: RD
Phone: 225-454-4435