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20111 Regina Rd, New Paris, IN 46553-9632 | |
(574) 202-0704 | |
(574) 831-6795 |
Full Name | |
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Type | Facility |
Speciality | Dietitian, Registered - Nutrition, Pediatric |
Location | 20111 Regina Rd, New Paris, Indiana |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
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1154496305 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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133V00000X | Dietitian, Registered | 37000537A (Indiana) | Primary |
133VN1004X | Dietitian, Registered - Nutrition, Pediatric | 37000537A (Indiana) | Primary |
Mailing Address | Practice Location Address |
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Po Box 629, 20111 Regina Road, New Paris, IN 46553-0629 Ph: (574) 202-0704 | 20111 Regina Rd, New Paris, IN 46553-9632 Ph: (574) 202-0704 |
Ms. Karla Jean Minter, MPH, RD, CD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 20111 Regina Rd, New Paris, IN 46553 Phone: 574-202-0704 Fax: 574-831-6795 |