Healthcare Provider Details

I. General information

NPI: 1134766736
Provider Name (Legal Business Name): LAUREN E HARRISON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 RED ROCK RD
INDIANAPOLIS IN
46236-9358
US

IV. Provider business mailing address

7345 RED ROCK RD
INDIANAPOLIS IN
46236-9358
US

V. Phone/Fax

Practice location:
  • Phone: 765-661-5474
  • Fax:
Mailing address:
  • Phone: 765-661-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number37002501A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: