Provider Demographics
NPI:1760428767
Name:SPANIER, BETH ANN (RD)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:SPANIER
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 1:5607 S 21ST PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3456
Mailing Address - Country:US
Mailing Address - Phone:480-610-6111
Mailing Address - Fax:480-610-6189
Practice Address - Street 1:2149 E WARNER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3494
Practice Address - Country:US
Practice Address - Phone:480-610-6111
Practice Address - Fax:480-610-6189
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL875189133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL875189OtherAMERICAN DIETETIC ASSOC