Healthcare Provider Details

I. General information

NPI: 1104538503
Provider Name (Legal Business Name): BETH MARIE BATTLES RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH MARIE HEISE RD, LDN

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 COLLEGE AVE
QUINCY IL
62301-2600
US

IV. Provider business mailing address

1107 COLLEGE AVE
QUINCY IL
62301-2600
US

V. Phone/Fax

Practice location:
  • Phone: 217-214-5800
  • Fax:
Mailing address:
  • Phone: 217-214-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: