Provider Demographics
NPI:1073759171
Name:ALLISON, BETH A (RD, LDN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:ALLISON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4172
Mailing Address - Country:US
Mailing Address - Phone:978-479-6964
Mailing Address - Fax:
Practice Address - Street 1:36 BAYBERRY RD
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4172
Practice Address - Country:US
Practice Address - Phone:978-479-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-20
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA576250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered