Provider Demographics
NPI:1265072474
Name:BEAL, CRISTINA MARIA (RD)
Entity type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:MARIA
Last Name:BEAL
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 1:361 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49070-8702
Mailing Address - Country:US
Mailing Address - Phone:269-271-7325
Mailing Address - Fax:
Practice Address - Street 1:361 116TH AVE
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:MI
Practice Address - Zip Code:49070-8702
Practice Address - Country:US
Practice Address - Phone:269-271-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86151081133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered