Provider Demographics
NPI:1013749779
Name:SPENCER, MARGARET ANN (RD LD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 WOODRUFF PLACE WEST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1945
Mailing Address - Country:US
Mailing Address - Phone:317-650-9127
Mailing Address - Fax:
Practice Address - Street 1:8402 HARCOURT RD STE 501
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2054
Practice Address - Country:US
Practice Address - Phone:317-338-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000967A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered