Provider Demographics
NPI:1063844587
Name:SMITH, ELLEN ELIZABETH (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 PONTCHARTRAIN BLVD
Mailing Address - Street 2:410
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2440
Mailing Address - Country:US
Mailing Address - Phone:409-651-2222
Mailing Address - Fax:
Practice Address - Street 1:8600 PONTCHARTRAIN BLVD
Practice Address - Street 2:410
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-2440
Practice Address - Country:US
Practice Address - Phone:409-651-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2475133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered