Basic Information
| Provider Information | |||||||||
| NPI: | 1912347717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVERIO | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | MINNICK | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, RD, CD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2325 18TH ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123750272 | ||||||||
| FaxNumber: | 8123751093 | ||||||||
| Practice Location | |||||||||
| Address1: | 2325 18TH ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123750272 | ||||||||
| FaxNumber: | 8123751093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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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 | 133VN1005X | 37000553A | IN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal |
No ID Information.