Provider Demographics
NPI:1518004415
Name:ANDERSON, ELISABETH D (RD)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 STAGE COACH TRL
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8271
Mailing Address - Country:US
Mailing Address - Phone:817-596-3499
Mailing Address - Fax:817-596-3499
Practice Address - Street 1:1301 PENNSYLVANIA AVE
Practice Address - Street 2:HARRIS METHODIST HOSPITAL DIABETES CTR.
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2122
Practice Address - Country:US
Practice Address - Phone:817-250-2922
Practice Address - Fax:817-250-3718
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04789133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic