Provider Demographics
NPI:1598076432
Name:WEBER, RENEE SUE (MA, RD, CD, CDE)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:SUE
Last Name:WEBER
Suffix:
Gender:F
Credentials:MA, RD, CD, CDE
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:SUE
Other - Last Name:COVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, RD, CD, CDE
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-944-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001858A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001006284OtherANTHEM PTAN
IN264430412OtherMEDICARE PTAN