Active NPI
Stacey Bolander, RDN, RN
- Registered Dietitian
- Indianapolis, IN
National Provider Identifier
1720620503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 37000665
- Practice address
- 5510 S East St Ste H
Indianapolis, IN 46227-1938 - Phone
- (317) 924-8425
- NPI assigned
- Oct 12, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 37000665 | IN | Primary |
Addresses
Primary practice location
5510 S East St Ste H
Indianapolis, IN 46227-1938
Mailing address
5946 Aldridge Dr
Whitestown, IN 46075-4419
Phone (317) 506-0814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37000665 | IN | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570838400000",
"number": "1720620503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5946 ALDRIDGE DR",
"city": "WHITESTOWN",
"state": "IN",
"postal_code": "460754419",
"telephone_number": "317-506-0814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5510 S EAST ST STE H",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462271938",
"telephone_number": "317-924-8425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLANDER",
"first_name": "STACEY",
"credential": "RDN, RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-12",
"last_updated": "2019-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IN",
"license": "37000665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.