MEDICARE: MR. NICHOLAS E GARNER RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	86040185	IN

General Provider Information

NPI Number	:	1730048273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS E GARNER RDN

Provider Business Mailing Address
First Line	:	1334 WALDEMERE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-3319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 WALDEMERE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-3319
Country	:	US
Telephone Number	:	317-308-8375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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