Provider Demographics
NPI:1689985004
Name:VELAZQUEZ, KATE MARIE (RD, CD)
Entity Type:Individual
Prefix:MISS
First Name:KATE
Middle Name:MARIE
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:LAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:8111 S EMERSON AVE STE 150
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8601
Practice Address - Country:US
Practice Address - Phone:317-528-1950
Practice Address - Fax:317-528-1960
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002009A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN37002009AOtherIN STATE LIC