Provider Demographics
NPI:1528364247
Name:HOCKEMEYER, TRISHA L (RD)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:L
Last Name:HOCKEMEYER
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 1:1234 E DUPONT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9965
Mailing Address - Fax:260-458-5664
Practice Address - Street 1:8028 CARNEGIE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5787
Practice Address - Country:US
Practice Address - Phone:260-755-6233
Practice Address - Fax:260-422-4125
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001927A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000696175OtherANTHEM
IN000000696201OtherANTHEM
IN000000696204OtherANTHEM
IN000000696195OtherANTHEM
IN000000696205OtherANTHEM