Individual
ELIZABETH S MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
6640 INTECH BLVD STE 195, INDIANAPOLIS, IN 46278-2014
(317) 295-0608
Mailing address
6640 INTECH BLVD STE 195, INDIANAPOLIS, IN 46278-2014
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37003932A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104125379
ANTHEM PTAN
IN
Enumeration date
02/15/2024
Last updated
05/06/2024
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