Provider Demographics
NPI:1053427211
Name:BALLESTEROS BONO, MARIA RITA (RN, RD, CDCES, MS)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:RITA
Last Name:BALLESTEROS BONO
Suffix:
Gender:F
Credentials:RN, RD, CDCES, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-1999
Mailing Address - Country:US
Mailing Address - Phone:406-898-1957
Mailing Address - Fax:406-898-1959
Practice Address - Street 1:3905 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-1999
Practice Address - Country:US
Practice Address - Phone:406-898-1957
Practice Address - Fax:406-898-1959
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT358712-4901133V00000X
UT358712-3102163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered