Provider Demographics
NPI:1417510496
Name:WEINANDY, ERICA (RD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WEINANDY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3589
Mailing Address - Country:US
Mailing Address - Phone:312-593-0172
Mailing Address - Fax:
Practice Address - Street 1:3221 BEACON PKWY
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-7196
Practice Address - Country:US
Practice Address - Phone:574-647-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1065650133V00000X
IL164.005687133V00000X
IN37002468A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE