Provider Demographics
NPI:1851775720
Name:COUTURE, JANELLE (RDN, CD)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:COUTURE
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 WHITEGATE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-2440
Mailing Address - Country:US
Mailing Address - Phone:260-341-9440
Mailing Address - Fax:
Practice Address - Street 1:2927 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5415
Practice Address - Country:US
Practice Address - Phone:260-745-1200
Practice Address - Fax:260-745-5968
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1103410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered