Provider Demographics
NPI:1225661028
Name:SMITH, ELENA NICOLE (RDN, LD)
Entity Type:Individual
Prefix:MISS
First Name:ELENA
Middle Name:NICOLE
Last Name:SMITH
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 1:437 CLARANNA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1827
Mailing Address - Country:US
Mailing Address - Phone:740-707-4459
Mailing Address - Fax:
Practice Address - Street 1:437 CLARANNA AVE APT 3
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-1827
Practice Address - Country:US
Practice Address - Phone:740-707-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered