Individual
AMY M BOBALIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
5 MATCHETT DR, US HWY 30 W, PIERCETON, IN 46562-9073
(574) 594-2136
(574) 594-2281
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37001977A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000675021
ANTHEM
IN
01
—
000000675210
ANTHEM
IN
01
—
000000675220
ANTHEM
IN
Enumeration date
08/12/2010
Last updated
03/25/2013
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