Provider Demographics
NPI:1033663612
Name:ELIASON, ARLENE (RD, LN, CDE)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:ELIASON
Suffix:
Gender:F
Credentials:RD, LN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 HIGHLAND BLVD
Mailing Address - Street 2:SUITE 2180
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6904
Mailing Address - Country:US
Mailing Address - Phone:406-414-5331
Mailing Address - Fax:406-414-5332
Practice Address - Street 1:935 HIGHLAND BLVD
Practice Address - Street 2:SUITE 2180
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6904
Practice Address - Country:US
Practice Address - Phone:406-414-5331
Practice Address - Fax:406-414-5332
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
09420207OtherCERTIFIED DIABETES EDUCATOR NUMBER
MT523OtherMED-NUTR-LICENSE NUMBER