NPI 1720620503 · live from the CMS NPI Registry
Stacey Bolander, RDN, RN
Dietitian, Registered in Indianapolis, IN. National Provider Identifier 1720620503, active.
NPI record
| NPI | 1720620503 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 5510 S East St Ste H, Indianapolis, IN 46227 |
| Practice phone | 317-924-8425 |
| Mailing address | 5946 Aldridge Dr, Whitestown, IN 46075 |
| Enumerated | October 12, 2019 |
| Last updated | October 12, 2019 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 37000665 (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.