Provider Demographics
NPI:1710111679
Name:ROCHE, PATRICIA L (MS, RD, CD)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 GORHAM CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-3280
Mailing Address - Country:US
Mailing Address - Phone:317-850-8497
Mailing Address - Fax:
Practice Address - Street 1:1598 TALLULAH TER
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-7218
Practice Address - Country:US
Practice Address - Phone:317-850-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
564375133NN1002X, 133V00000X, 133VN1004X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3178508497Medicaid
IN3178508497Medicare NSC
IN3178508497Medicaid
IN3178508497Medicare UPIN
IN3178508497Medicare PIN