Provider Demographics
NPI:1477923118
Name:GEARIN, ELIZABETH MADONNA (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MADONNA
Last Name:GEARIN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:MADONNA
Other - Last Name:GOECKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:2655 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-3617
Mailing Address - Country:US
Mailing Address - Phone:937-325-1531
Mailing Address - Fax:
Practice Address - Street 1:2655 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-3617
Practice Address - Country:US
Practice Address - Phone:937-325-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7652133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered