Individual
ALEXA ROE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37002677A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001040805
ANTHEM PROVIDER NUMBER
IN
Enumeration date
06/17/2016
Last updated
10/14/2016
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