Provider Demographics
NPI:1346255882
Name:BIESECKER, RONNA LEE (PHD RD)
Entity Type:Individual
Prefix:
First Name:RONNA
Middle Name:LEE
Last Name:BIESECKER
Suffix:
Gender:F
Credentials:PHD RD
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 40936
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85717
Mailing Address - Country:US
Mailing Address - Phone:520-299-4345
Mailing Address - Fax:
Practice Address - Street 1:6420 E BROADWAY
Practice Address - Street 2:BLDG C 300
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-299-4345
Practice Address - Fax:520-519-2434
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R640970133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ917429OtherAHCCCS
AZ917429OtherAHCCCS