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General NPI Number Information
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NPI Number | 1043028509
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Entity Type | Organization
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Legal Business Name | FUEL WITH PURPOSE
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 5928 CONKRIGHT LN
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-8548
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Country | US
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Telephone | 405-985-1417
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Fax |
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Provider Business Mailing Address
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Address Line | 5928 CONKRIGHT LN
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-8548
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Country | US
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Telephone | 405-985-1417
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Fax |
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Authorized Official
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Title or Position | SPORTS DIETITIAN
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Name | MRS. ELAINE WANSTREET
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Credential | RD, CSSD
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Telephone | 405-985-1417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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