Individual
ELAINE GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.N.T.
Contact information
Practice address
5230 E STOP 11 RD, SUITE 150, INDIANAPOLIS, IN 46237-6339
(317) 865-5904
(317) 865-5321
Mailing address
PO BOX 664056, INDIANAPOLIS, IN 46266-4056
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
—
—
Other
Enumeration date
07/23/2006
Last updated
02/22/2013
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