Provider Demographics
NPI:1295492270
Name:GROSS, CHARNE (RDN)
Entity type:Individual
Prefix:
First Name:CHARNE
Middle Name:
Last Name:GROSS
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 1:112 N BOEHNING ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5518
Mailing Address - Country:US
Mailing Address - Phone:317-832-6584
Mailing Address - Fax:
Practice Address - Street 1:435 E MAIN ST STE 175
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1463
Practice Address - Country:US
Practice Address - Phone:317-832-6584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86150638133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered