Provider Demographics
NPI:1568615250
Name:BLIKE, LIZABETH ANNE (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:LIZABETH
Middle Name:ANNE
Last Name:BLIKE
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:LIZABETH
Other - Middle Name:ANNE
Other - Last Name:BYNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CD
Mailing Address - Street 1:PO BOX 271220
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1220
Mailing Address - Country:US
Mailing Address - Phone:801-268-7860
Mailing Address - Fax:801-270-3331
Practice Address - Street 1:1200 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1300
Practice Address - Country:US
Practice Address - Phone:801-268-7860
Practice Address - Fax:801-270-3331
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4975885-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered