Provider Demographics
NPI:1376975011
Name:MICHAELS, ELIZABETH A (MS RDN LDN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MS RDN LDN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MICHAELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS RDN LDN
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:4241 HWY 14 W
Practice Address - Street 2:
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822-1037
Practice Address - Country:US
Practice Address - Phone:618-724-2401
Practice Address - Fax:618-724-4628
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004591174H00000X
IL164.004591133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator