Provider Demographics
NPI:1659658045
Name:BLAIR, BETH NICOLE (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:NICOLE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:NICOLE
Other - Last Name:ZIELINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8866 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2283
Mailing Address - Country:US
Mailing Address - Phone:812-760-9472
Mailing Address - Fax:
Practice Address - Street 1:6211 WATERFORD BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2869
Practice Address - Country:US
Practice Address - Phone:812-465-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN945242133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered