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General NPI Number Information
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NPI Number | 1891653614
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Entity Type | Individual
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Provider Name | MIA EIDE RDN
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Gender | Female
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 6124 E BROWN RD STE 102
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City | MESA
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State | AZ
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Zip | 85205-4959
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Country | US
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Telephone | 480-809-6513
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Fax | 480-809-6823
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Provider Business Mailing Address
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Address Line | 1301 N SCOTTSDALE RD APT 1053
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3457
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Country | US
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Telephone | 320-212-4222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86418972
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License Number State | AZ
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