Healthcare Provider Details

I. General information

NPI: 1649951161
Provider Name (Legal Business Name): CHLOEE HURST RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 W HONEY CREEK PKWY
TERRE HAUTE IN
47802-6700
US

IV. Provider business mailing address

70 W HONEY CREEK PKWY
TERRE HAUTE IN
47802-6700
US

V. Phone/Fax

Practice location:
  • Phone: 812-230-3937
  • Fax:
Mailing address:
  • Phone: 812-235-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37003782A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: