Healthcare Provider Details

I. General information

NPI: 1619701489
Provider Name (Legal Business Name): BETH LOUISA METZLER MS, RDN, CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 WISHARD BLVD STE 1100
INDIANAPOLIS IN
46202-4164
US

IV. Provider business mailing address

975 W WALNUT ST IB 130
INDIANAPOLIS IN
46202-5181
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-3966
  • Fax: 317-968-1354
Mailing address:
  • Phone: 317-944-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number37002620A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number37002620A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number37002620A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: