Provider Demographics
NPI:1073132312
Name:WALKER, ELIZABETH HANNAH (RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HANNAH
Last Name:WALKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 N DAMEN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4683
Mailing Address - Country:US
Mailing Address - Phone:614-205-2187
Mailing Address - Fax:
Practice Address - Street 1:1924 N DAMEN AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4683
Practice Address - Country:US
Practice Address - Phone:614-205-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86119376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered