Healthcare Provider Details

I. General information

NPI: 1417198714
Provider Name (Legal Business Name): BETH E STEFURA RD.,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 OLD OAK DR
CORTLAND OH
44410-1122
US

IV. Provider business mailing address

236 OLD OAK DR
CORTLAND OH
44410-1122
US

V. Phone/Fax

Practice location:
  • Phone: 330-727-6254
  • Fax:
Mailing address:
  • Phone: 330-727-6254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number716810
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: