Provider Demographics
NPI:1528117637
Name:BEESON, ROBIN L (MS, RDN, CD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:BEESON
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16027 81ST AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6867
Mailing Address - Country:US
Mailing Address - Phone:253-678-7617
Mailing Address - Fax:
Practice Address - Street 1:7808 PACIFIC AVE STE 3
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7039
Practice Address - Country:US
Practice Address - Phone:253-503-6178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001160133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8284143Medicaid
WA0039581OtherLABOR AND INDUSTRIES #
WAUS2557117OtherAETNA SPECIALIST PIN
WA710000663OtherRAILROAD MC #
WA7782BAOtherBLUE SHIELD #
P55764Medicare UPIN
WAAB28009Medicare PIN