NPI 1164062774 · live from the CMS NPI Registry
Hannah Gabrielle Bercot
Dietitian, Registered in Fort Wayne, IN. National Provider Identifier 1164062774, active.
NPI record
| NPI | 1164062774 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 11108 Parkview Circle Dr, Fort Wayne, IN 46845 |
| Practice phone | 260-266-5700 |
| Mailing address | 11109 Parkview Plaza Dr # 117, Fort Wayne, IN 46845 |
| Enumerated | January 11, 2020 |
| Last updated | May 7, 2021 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 37003033A (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.