Provider Demographics
NPI:1225733280
Name:GARDEN, BEVERLY (RD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:GARDEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 ROLLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9492
Mailing Address - Country:US
Mailing Address - Phone:570-898-9038
Mailing Address - Fax:
Practice Address - Street 1:719 ROLLING GREEN DR
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9492
Practice Address - Country:US
Practice Address - Phone:570-898-9038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88346133V00000X
FLND17707133V00000X
PADN002775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered