Healthcare Provider Details

I. General information

NPI: 1861561912
Provider Name (Legal Business Name): STEPHANIE ANNE THOMPSON R.D., C.D., C.N.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W UNIVERSITY AVE DIETETICS DEPT.
MUNCIE IN
47303-3499
US

IV. Provider business mailing address

1869 N 940 W
PARKER CITY IN
47368-9128
US

V. Phone/Fax

Practice location:
  • Phone: 765-747-3273
  • Fax: 765-741-2994
Mailing address:
  • Phone: 765-468-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: