Provider Demographics
NPI:1790143105
Name:BIEBER, MARIE LYNN (RD)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LYNN
Last Name:BIEBER
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 1:919 WINTON RD S STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1637
Mailing Address - Country:US
Mailing Address - Phone:585-445-4610
Mailing Address - Fax:585-270-6919
Practice Address - Street 1:919 WINTON RD S STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-445-4610
Practice Address - Fax:585-270-6919
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2018-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86033283133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered