MEDICARE: MRS. DANA MARIE BEALS RD, CD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1851881221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA MARIE BEALS RD, CD

Provider Business Mailing Address
First Line	:	642 W GREEN RD
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-4327
Country	:	US
Telephone Number	:	765-506-1581
Fax Number	:

Provider Business Practice Location Address
First Line	:	642 W GREEN RD
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-4327
Country	:	US
Telephone Number	:	765-506-1581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2018
Last Update Date	:	06/09/2025

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