Provider Demographics
NPI:1275124422
Name:ELLIS, ESTHER LIANA (RDN)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:LIANA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 SAW MILL RIVER RD APT 3F
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1819
Mailing Address - Country:US
Mailing Address - Phone:225-803-3177
Mailing Address - Fax:
Practice Address - Street 1:1200 N ASHLAND AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8327
Practice Address - Country:US
Practice Address - Phone:872-256-6359
Practice Address - Fax:312-604-5120
Is Sole Proprietor?:No
Enumeration Date:2021-01-31
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86048691133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered