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MS. MIRANDA KATE BEASON RD
>> Dietitian, Registered >> Dietary & Nutritional Service ProvidersRegistrant NPI Number: 1912003716
Individual Registrant:MS. MIRANDA KATE BEASON RD
Gender: F
Sole Proprietor
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
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
Tel: 719-530-2293 Fax: 719-530-2232
Registration Information:
NPI: 1912003716
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 133V00000X | Dietary & Nutritional Service Providers Dietitian, Registered | NE | 00934419 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
