Provider Demographics
NPI:1467765172
Name:KNOTTS, BETH MARIE LEY (PHD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE LEY
Last Name:KNOTTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 KAYLA LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55341-4505
Mailing Address - Country:US
Mailing Address - Phone:763-391-7636
Mailing Address - Fax:763-424-7638
Practice Address - Street 1:75 HAMEL RD
Practice Address - Street 2:
Practice Address - City:HAMEL
Practice Address - State:MN
Practice Address - Zip Code:55340-4567
Practice Address - Country:US
Practice Address - Phone:763-478-3978
Practice Address - Fax:763-478-3502
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education