Provider Demographics
NPI:1063179778
Name:STITT, BETRINA (RDN)
Entity type:Individual
Prefix:
First Name:BETRINA
Middle Name:
Last Name:STITT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9630 MEADOWLAND CT
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1151
Mailing Address - Country:US
Mailing Address - Phone:616-795-3135
Mailing Address - Fax:
Practice Address - Street 1:9630 MEADOWLAND CT
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1151
Practice Address - Country:US
Practice Address - Phone:616-795-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered