Provider Demographics
NPI:1093161580
Name:OFFENBERGER, ELISABETH (MS,RD,LDN,CDCES)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:OFFENBERGER
Suffix:
Gender:F
Credentials:MS,RD,LDN,CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S 31ST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-3506
Mailing Address - Country:US
Mailing Address - Phone:304-580-6714
Mailing Address - Fax:
Practice Address - Street 1:1401 S 31ST ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-3506
Practice Address - Country:US
Practice Address - Phone:304-580-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4102133V00000X
PADN007606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered