Healthcare Provider Details

I. General information

NPI: 1194371906
Provider Name (Legal Business Name): CHRISTINE MARIE LAKER MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 S FLATROCK RIVER RD
RUSHVILLE IN
46173-9248
US

IV. Provider business mailing address

2017 S FLATROCK RIVER RD
RUSHVILLE IN
46173-9248
US

V. Phone/Fax

Practice location:
  • Phone: 317-645-6238
  • Fax:
Mailing address:
  • Phone: 317-645-6238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4826
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: