Provider Demographics
NPI:1336481944
Name:LEES, ELIZABETH (MS, RDN, CGN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LEES
Suffix:
Gender:F
Credentials:MS, RDN, CGN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 E INDIANOLA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5906
Mailing Address - Country:US
Mailing Address - Phone:630-222-9264
Mailing Address - Fax:
Practice Address - Street 1:1816 E INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5906
Practice Address - Country:US
Practice Address - Phone:630-222-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1062302133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered