Provider Demographics
NPI:1457491052
Name:JONES, ELIZABETH R (CTN, CCN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:CTN, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 BACK WINDHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST TOWNSHEND
Mailing Address - State:VT
Mailing Address - Zip Code:05359-9722
Mailing Address - Country:US
Mailing Address - Phone:802-874-4429
Mailing Address - Fax:802-302-1004
Practice Address - Street 1:1759 BACK WINDHAM RD
Practice Address - Street 2:
Practice Address - City:WEST TOWNSHEND
Practice Address - State:VT
Practice Address - Zip Code:05359
Practice Address - Country:US
Practice Address - Phone:802-874-4429
Practice Address - Fax:802-302-1004
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTMT0815Medicare ID - Type UnspecifiedNUTRITION EDUCATOR