Provider Demographics
NPI:1326607060
Name:BAKER, ELIZABETH (RDN, LMNT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:RDN, LMNT
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, LMNT
Mailing Address - Street 1:3128 PURITAN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4230
Mailing Address - Country:US
Mailing Address - Phone:402-202-3617
Mailing Address - Fax:
Practice Address - Street 1:3128 PURITAN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4230
Practice Address - Country:US
Practice Address - Phone:402-202-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013030991133V00000X
NE1327133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered