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MS. MIRANDA KATE BEASON RD

>> Dietitian, Registered >> Dietary & Nutritional Service Providers

Registrant NPI Number: 1912003716

Individual Registrant:
MS. MIRANDA KATE BEASON RD
Gender: F
Sole Proprietor

Location and contact information for practice:
448 E 1ST ST  SALIDA, CO 81201-2804 US
Tel: 719-530-2293  Fax: 719-530-2232

Contact information for business:
PO BOX 616  PONCHA SPRINGS, CO 81242-0616 US
Tel: 719-530-2293  Fax: 719-530-2232

Registration Information:
NPI: 1912003716
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y133V00000XDietary & Nutritional Service Providers
Dietitian, Registered
NE00934419

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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