Provider Demographics
NPI:1134796188
Name:FAINE, ELLA MARIE (RD)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:MARIE
Last Name:FAINE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 S ALAN PL
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4485
Mailing Address - Country:US
Mailing Address - Phone:260-433-9560
Mailing Address - Fax:
Practice Address - Street 1:401 OHIO ST STE B3
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3543
Practice Address - Country:US
Practice Address - Phone:260-433-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86101841133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered