Provider Demographics
NPI:1376828616
Name:KOHLMEYER, ANDREA CATHERINE (RD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CATHERINE
Last Name:KOHLMEYER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:CATHERINE
Other - Last Name:WILZBACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2340 E 350 S
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670
Mailing Address - Country:US
Mailing Address - Phone:812-598-0993
Mailing Address - Fax:
Practice Address - Street 1:2340 E 350 S
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670
Practice Address - Country:US
Practice Address - Phone:812-598-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1025304133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered