Basic Information
| Provider Information | |||||||||
| NPI: | 1851881221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEALS | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RD, CD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 335 N HILLSDALE DR | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474084225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655061581 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2605 E CREEKS EDGE DR | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474018368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123552300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2018 | ||||||||
| LastUpdateDate: | 05/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.