1801151345 NPI number — MRS. ELIZABETH ANNE TAPP M.S, R.D., C.L.T.

Table of content: ANYA SANDUSKY (NPI 1871152694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801151345 NPI number — MRS. ELIZABETH ANNE TAPP M.S, R.D., C.L.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAPP
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S, R.D., C.L.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801151345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6308 SILVERTON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46237-3159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-292-2354
Provider Business Mailing Address Fax Number:
886-570-9131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2267 S HUNTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46239-9575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-292-2354
Provider Business Practice Location Address Fax Number:
886-570-9131
Provider Enumeration Date:
07/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1015420 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000877826 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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