Provider Demographics
NPI:1871218107
Name:BUDD, VICTORIA R (RD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:BUDD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:R
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:404 E WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2609
Practice Address - Country:US
Practice Address - Phone:317-944-3500
Practice Address - Fax:317-962-2474
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003571A133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1102269486OtherANTHEM PTAN
INQ00624781OtherRAILROAD PTAN
IN264430G19OtherMEDICARE PTAN