Provider Demographics
NPI:1013753052
Name:PARSON, DALLAS RAE (MA, RD, LD)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:RAE
Last Name:PARSON
Suffix:
Gender:F
Credentials:MA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11496 HARLEQUIN LN APT 306
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2471
Mailing Address - Country:US
Mailing Address - Phone:812-550-6890
Mailing Address - Fax:
Practice Address - Street 1:11496 HARLEQUIN LN APT 306
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2471
Practice Address - Country:US
Practice Address - Phone:812-550-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86058615133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered