Provider Demographics
NPI:1831692524
Name:NELSON, BETHANY MARIE (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MARIE
Other - Last Name:SHIPPEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:50 MEMORIAL DR STE 113
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2238
Mailing Address - Country:US
Mailing Address - Phone:978-466-4580
Mailing Address - Fax:
Practice Address - Street 1:50 MEMORIAL DR STE 113
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2238
Practice Address - Country:US
Practice Address - Phone:978-166-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered