Healthcare Provider Details

I. General information

NPI: 1740056019
Provider Name (Legal Business Name): KEIRA E KROIN MSC, CNS CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 N MERIDIAN ST STE 101
INDIANAPOLIS IN
46260-5306
US

IV. Provider business mailing address

11520 MONON FARMS LN
CARMEL IN
46032-3302
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-8048
  • Fax:
Mailing address:
  • Phone: 317-690-9146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: