Provider Demographics
NPI:1669089116
Name:BLY, BRIGITTA (RD)
Entity type:Individual
Prefix:
First Name:BRIGITTA
Middle Name:
Last Name:BLY
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 1:6500 E STEAMBOAT TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-8541
Mailing Address - Country:US
Mailing Address - Phone:605-496-1588
Mailing Address - Fax:
Practice Address - Street 1:2333 W 57TH ST STE 103
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5054
Practice Address - Country:US
Practice Address - Phone:605-271-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered