Provider Demographics
NPI:1861561912
Name:THOMPSON, STEPHANIE ANNE (RD, CD, CNSD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD, CD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 N 940 W
Mailing Address - Street 2:
Mailing Address - City:PARKER CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47368-9128
Mailing Address - Country:US
Mailing Address - Phone:765-468-9151
Mailing Address - Fax:
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:DIETETICS DEPT.
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3499
Practice Address - Country:US
Practice Address - Phone:765-747-3273
Practice Address - Fax:765-741-2994
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN296500ZMedicare ID - Type UnspecifiedUPLAND HEALTH & DIAG.
IN940810MMedicare Oscar/Certification