Provider Demographics
NPI:1861868234
Name:BAUDLER, BENJAMIN (RDN, LD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BAUDLER
Suffix:
Gender:M
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5726
Mailing Address - Country:US
Mailing Address - Phone:563-243-6162
Mailing Address - Fax:563-244-0903
Practice Address - Street 1:901 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5726
Practice Address - Country:US
Practice Address - Phone:563-243-6162
Practice Address - Fax:563-244-0903
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079043133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered