Individual
NICOLE HARMESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D., IBCLC
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 448-8858
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37002194A
IN
133V00000X
Registered Dietitian
CERT# 930819
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000769963
ANTHEM PROVIDER NUMBER
IN
Enumeration date
04/27/2012
Last updated
11/18/2014
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