Provider Demographics
NPI:1720705668
Name:GULBRANDSEN, TARI (RD)
Entity Type:Individual
Prefix:
First Name:TARI
Middle Name:
Last Name:GULBRANDSEN
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 1:26 N ARSENAL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3808
Mailing Address - Country:US
Mailing Address - Phone:317-632-0123
Mailing Address - Fax:
Practice Address - Street 1:26 N ARSENAL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3808
Practice Address - Country:US
Practice Address - Phone:317-632-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001825A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered