Provider Demographics
NPI:1184015141
Name:GARANT, AMANDA E (RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:GARANT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6640 INTECH BLVD
Mailing Address - Street 2:STE 195
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2011
Mailing Address - Country:US
Mailing Address - Phone:317-295-0608
Mailing Address - Fax:317-295-0622
Practice Address - Street 1:6640 INTECH BLVD
Practice Address - Street 2:STE 195
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2011
Practice Address - Country:US
Practice Address - Phone:317-295-0608
Practice Address - Fax:317-295-0622
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN37002024A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN210880001Medicare PIN