Basic Information
| Provider Information | |||||||||
| NPI: | 1003965245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STETLER | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | HEATHER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.D. C.D.E. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284800 | ||||||||
| FaxNumber: | 3178651479 | ||||||||
| Practice Location | |||||||||
| Address1: | 1116 N 16TH ST | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479042119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654285850 | ||||||||
| FaxNumber: | 7654285851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 37001459A | IN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 000001209978 | 01 | ANTHEM | OTHER | 300019321 | 05 | IN | MEDICAID | 14085423 | 01 | CAQH | OTHER |