Provider Demographics
NPI:1508577180
Name:PENN-WUORINEN, ELIZABETH JEAN (CDM, CFPP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:PENN-WUORINEN
Suffix:
Gender:F
Credentials:CDM, CFPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CREEKSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1950
Mailing Address - Country:US
Mailing Address - Phone:443-201-4589
Mailing Address - Fax:
Practice Address - Street 1:420 CREEKSIDE TRL
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:MD
Practice Address - Zip Code:21826-1950
Practice Address - Country:US
Practice Address - Phone:443-201-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No132700000XDietary & Nutritional Service ProvidersDietary Manager