Healthcare Provider Details

I. General information

NPI: 1932698917
Provider Name (Legal Business Name): SARAH ELIZABETH STILZ CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2018
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ILLINOIS ST STE 1600
INDIANAPOLIS IN
46204-4218
US

IV. Provider business mailing address

201 N ILLINOIS ST STE 1600
INDIANAPOLIS IN
46204-4218
US

V. Phone/Fax

Practice location:
  • Phone: 317-558-9410
  • Fax: 317-854-9216
Mailing address:
  • Phone: 317-558-9410
  • Fax: 317-854-9216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number79000093A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number79000093A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: