Provider Demographics
NPI:1073208666
Name:URIAS, MOLLY MARISSA (RDN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARISSA
Last Name:URIAS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57101-0210
Mailing Address - Country:US
Mailing Address - Phone:605-323-7222
Mailing Address - Fax:605-653-3042
Practice Address - Street 1:6540 S BEAL AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5187
Practice Address - Country:US
Practice Address - Phone:605-201-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0688133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered