Individual
JENNIFER CARON ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDE
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
(765) 449-5015
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37002238A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000791825
ANTHEM PROVIDER NUMBER
IN
Enumeration date
01/11/2012
Last updated
03/27/2014
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