Healthcare Provider Details

I. General information

NPI: 1558694380
Provider Name (Legal Business Name): ELAINE ROBBINS RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6923 HILLSDALE CT
INDIANAPOLIS IN
46250-2054
US

IV. Provider business mailing address

PO BOX 6036
FISHERS IN
46038-6036
US

V. Phone/Fax

Practice location:
  • Phone: 317-498-0244
  • Fax:
Mailing address:
  • Phone: 317-498-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001176A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: