Provider Demographics
NPI:1669409991
Name:BARC, DENISE A (RD)
Entity type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:A
Last Name:BARC
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11445 WILDERNESS TRL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4621
Mailing Address - Country:US
Mailing Address - Phone:317-988-2699
Mailing Address - Fax:317-988-2358
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2699
Practice Address - Fax:317-988-2358
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN712196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered