Provider Demographics
NPI:1215186812
Name:HIPPLE, ELIZABETH R (LD,RD,CDE)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:R
Last Name:HIPPLE
Suffix:
Gender:F
Credentials:LD,RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVENUE
Mailing Address - Street 2:BUSINESS OFFICE
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-4478
Mailing Address - Fax:603-740-2244
Practice Address - Street 1:10 MEMBERS WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5933
Practice Address - Country:US
Practice Address - Phone:603-742-1143
Practice Address - Fax:603-749-3509
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH000798801Medicare PIN