Provider Demographics
NPI:1316637812
Name:BE SQUARED NUTRITION LLC
Entity type:Organization
Organization Name:BE SQUARED NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:434-234-4591
Mailing Address - Street 1:515 PARK ST STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4769
Mailing Address - Country:US
Mailing Address - Phone:434-234-4591
Mailing Address - Fax:855-955-3898
Practice Address - Street 1:515 PARK ST STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4769
Practice Address - Country:US
Practice Address - Phone:434-234-4591
Practice Address - Fax:855-955-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
86012192OtherCOMMISSION ON DIETETIC REGISTRATION