Provider Demographics
NPI:1760054837
Name:MAGNUSON, ELLEN (RDN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 PROSPECT ST APT 306
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-0024
Mailing Address - Country:US
Mailing Address - Phone:612-877-1704
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD STE 1710
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:317-944-9269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered