Provider Demographics
NPI:1386701456
Name:EASTIN, TRINA (MA, RD,CD)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:EASTIN
Suffix:
Gender:F
Credentials:MA, RD,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-0456
Mailing Address - Country:US
Mailing Address - Phone:317-847-4225
Mailing Address - Fax:
Practice Address - Street 1:11979 SLOANE MUSE
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4158
Practice Address - Country:US
Practice Address - Phone:317-847-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000333A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered