Provider Demographics
NPI:1477044121
Name:REED, ELIZABETH (MPH, RDN, CNSC, LD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:MPH, RDN, CNSC, LD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:PALMER-REED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH, RDN, CNSC, LD
Mailing Address - Street 1:2105 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6828
Mailing Address - Country:US
Mailing Address - Phone:303-875-7347
Mailing Address - Fax:
Practice Address - Street 1:2105 STONY HILL RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6828
Practice Address - Country:US
Practice Address - Phone:303-875-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
725740133N00000X, 133NN1002X, 133V00000X, 133VN1006X
NM725740133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
7813360OtherTHE NATIONAL BOARD OF NUTRITION SUPPORT CERTIFICATION
NMLD-1298OtherSTATE OF NUEW MEXICO REGULATIONS & LICENSING DEPART NUTRITION AND DIETETICS PRAC
725740OtherACADEMY OF NUTRITION AND DIETETICS
NM873914Medicaid