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General NPI Number Information
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NPI Number | 1427773498
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Entity Type | Organization
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Legal Business Name | BUILT BY WIKOFF
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 928 E MINNESOTA ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-3920
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Country | US
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Telephone | 317-999-7853
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Fax |
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Provider Business Mailing Address
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Address Line | 928 E MINNESOTA ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-3920
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Country | US
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Telephone | 317-999-7853
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | ASHLEY EAVES
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Credential | RD
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Telephone | 317-999-7853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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