Provider Demographics
NPI:1093440760
Name:SOVIAK, CHRISTINE N (RD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:N
Last Name:SOVIAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 SILVERDALE CT
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7100
Mailing Address - Country:US
Mailing Address - Phone:513-313-9207
Mailing Address - Fax:
Practice Address - Street 1:1980 E 116TH ST STE 120B
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3515
Practice Address - Country:US
Practice Address - Phone:513-313-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN967167133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered