Organization
BE SQUARED NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETHANY BLALOCK RDN (OWNER)
(434) 234-4591
Entity
Organization
Contact information
Practice address
515 PARK ST STE C, CHARLOTTESVILLE, VA 22902-4769
(434) 234-4591
(855) 955-3898
Mailing address
515 PARK ST STE C, CHARLOTTESVILLE, VA 22902-4769
(434) 234-4591
(855) 955-3898
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86012192
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
05/09/2023
Last updated
05/09/2023
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