Healthcare Provider Details

I. General information

NPI: 1588765192
Provider Name (Legal Business Name): MONICA L. STRAHLEY MS RD CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WEST GILBERT STREET
MUNCIE IN
47304
US

IV. Provider business mailing address

2121 LAKE AVENUE
FORT WAYNE IN
46805-5100
US

V. Phone/Fax

Practice location:
  • Phone: 765-744-3469
  • Fax:
Mailing address:
  • Phone: 260-426-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number846841
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: