Justine Bender
Individual provider Active NPI Registered Dietitian · Goshen, IN
NPI 1194475434 · NPPES record last updated Mar 28, 2022
Key facts
- NPI
- 1194475434
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 37003452A (IN)
- Practice address
- 200 High Park Ave
Goshen, IN 46526-4810 - Phone
- (574) 364-2679
- NPI assigned
- Mar 28, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37003452A | IN | MD | Nutritionist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 37003452A | IN | |
| Registered Dietitian | 133V00000X | 37003452A | IN | Yes |
Addresses
Primary practice location
200 High Park Ave
Goshen, IN 46526-4810
Mailing address
1722 College Manor Dr
Goshen, IN 46526-5150
Other providers in Goshen, IN
- Jennifer Lynn Beer
- Tracie Dyann Belcher
- Chloe Bell
- Danae Eileen Bell
- Greggory A Bell
- Marie Bennion
- Julie Bergan
- James A Berndt
- Christine A Bernier
- Michael Bessesen
All providers in Goshen, IN · Registered Dietitian in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.