Individual
RAELYNN PROKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LD
Contact information
Practice address
220 VIRGINIA AVE, INDIANAPOLIS, IN 46204-3632
(614) 433-8315
Mailing address
220 VIRGINIA AVE, INDIANAPOLIS, IN 46204-3709
(614) 433-8315
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD.7270
OH
Other
Enumeration date
06/22/2020
Last updated
07/27/2020
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