Provider Demographics
NPI:1801151345
Name:TAPP, ELIZABETH ANNE (MS, RD, CLT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:TAPP
Suffix:
Gender:F
Credentials:MS, RD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 SILVERTON WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3159
Mailing Address - Country:US
Mailing Address - Phone:317-292-2354
Mailing Address - Fax:886-570-9131
Practice Address - Street 1:2267 S HUNTER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-9575
Practice Address - Country:US
Practice Address - Phone:317-292-2354
Practice Address - Fax:886-570-9131
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1015420133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000877826OtherANTHEM
IN677730014Medicare PIN