Provider Demographics
NPI:1962072124
Name:DIETITIAN APPROVED NUTRITION, LLC
Entity type:Organization
Organization Name:DIETITIAN APPROVED NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:317-835-9871
Mailing Address - Street 1:11641 SANDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-6038
Mailing Address - Country:US
Mailing Address - Phone:317-835-9871
Mailing Address - Fax:317-836-2493
Practice Address - Street 1:11641 SANDWOOD CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-6038
Practice Address - Country:US
Practice Address - Phone:317-835-9871
Practice Address - Fax:317-836-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty