Provider Demographics
NPI:1518243765
Name:LOVE, ALYSON BETH (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:BETH
Last Name:LOVE
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:BETH
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CD
Mailing Address - Street 1:720 ESKENAZI AVENUE
Mailing Address - Street 2:FIFTH THIRD BANK BLDG., 5TH FLOOR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-3851
Mailing Address - Fax:317-692-2353
Practice Address - Street 1:6940 MICHIGAN RD STE 140
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2800
Practice Address - Country:US
Practice Address - Phone:317-266-2901
Practice Address - Fax:317-266-2916
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1033415133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered