Provider Demographics
NPI:1407988983
Name:CRAKER, VICKIE (RD,CSP,CD)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:CRAKER
Suffix:
Gender:F
Credentials:RD,CSP,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:100 NAVARRE PL STE 5550
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1169
Practice Address - Country:US
Practice Address - Phone:574-647-2550
Practice Address - Fax:574-647-1129
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000652A133V00000X
IN482338133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric