Provider Demographics
NPI:1093578528
Name:THOMAS, ALEXANDREA (RDN)
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11222 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IN
Mailing Address - Zip Code:46743-9779
Mailing Address - Country:US
Mailing Address - Phone:260-414-6179
Mailing Address - Fax:
Practice Address - Street 1:11050 PARKVIEW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1739
Practice Address - Country:US
Practice Address - Phone:260-266-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86108134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered