NPI 1023045200

Laverne a Sullivan, RD

Practitioner Registered Dietitian Fort Wayne, IN

Practice location

Address: 4210 Flagstaff Cv, Fort Wayne, IN 46815-4417
Phone: (260) 489-9009
Fax: (260) 489-5057
Mailing address: 5244 Jeffries Lane, Newburgh, IN 47630

Registered specialties

Registered Dietitian Primary

Dietary & Nutritional Service Providers Taxonomy 133V00000X Licence 37000748A (IN)

Other Dietitian, Registered providers in Indiana →

Registry record

NPI: 1023045200
Entity type: Individual
Sex (as registered): Female
NPI issued: 26 Jun 2006
Record last updated: 1 Jul 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.