Provider Demographics
NPI:1083230023
Name:MORTON, ELIZABETH K (RDN, LD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:MORTON
Suffix:
Gender:F
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 1:1519 WILLOW CREEK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1326
Mailing Address - Country:US
Mailing Address - Phone:803-413-5899
Mailing Address - Fax:
Practice Address - Street 1:1501 SUMTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2829
Practice Address - Country:US
Practice Address - Phone:803-413-5899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
SC516133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC516OtherS C LABOR LICENSING REGULATION (SCLLR) (LICENSED DIETITIAN LD)
835540OtherCOMMISSION ON DIETETIC REGISTRATION (CDR) (REGISTERED DIETITIAN NUTRITIONIST RDN