Provider Demographics
NPI:1558604207
Name:STACHLER, JENNIFER M (RD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:STACHLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:WILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3423
Mailing Address - Fax:765-983-7924
Practice Address - Street 1:1050 REID PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1155
Practice Address - Country:US
Practice Address - Phone:765-983-3423
Practice Address - Fax:765-983-7924
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1019905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN259370062Medicare PIN