Provider Demographics
NPI:1316556715
Name:MORAN, ELEANOR F (RDN)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:F
Last Name:MORAN
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 1:1509 EVENSTAR BLVD APT 130
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2884
Mailing Address - Country:US
Mailing Address - Phone:765-215-5932
Mailing Address - Fax:
Practice Address - Street 1:1509 EVENSTAR BLVD APT 130
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2884
Practice Address - Country:US
Practice Address - Phone:765-215-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003174A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered