Provider Demographics
NPI:1336172865
Name:BESELER, LUCILLE (MS, RD, LD/N)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:
Last Name:BESELER
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20423 ST RD 7
Mailing Address - Street 2:SUITE F6 BOX 340
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6792
Mailing Address - Country:US
Mailing Address - Phone:954-360-7883
Mailing Address - Fax:954-360-7884
Practice Address - Street 1:20483 VIA MARISA
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6708
Practice Address - Country:US
Practice Address - Phone:954-360-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL215435OtherAMERIGROUP
FL681581296Medicaid
FL4533713OtherAETNA
FLN0016OtherBLUE CROSS