Provider Demographics
NPI:1417198714
Name:STEFURA, BETH E (RD,LD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:E
Last Name:STEFURA
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 OLD OAK DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1122
Mailing Address - Country:US
Mailing Address - Phone:330-727-6254
Mailing Address - Fax:
Practice Address - Street 1:236 OLD OAK DR
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1122
Practice Address - Country:US
Practice Address - Phone:330-727-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH716810133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH#BC00304OtherBCMH