Provider Demographics
NPI:1518472539
Name:JONES, ELLEN EASTER (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:EASTER
Last Name:JONES
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:CALISON
Other - Last Name:EASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1712 SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1712 SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2640
Practice Address - Country:US
Practice Address - Phone:336-209-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004958133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered