Provider Demographics
NPI:1598049637
Name:BLOW, ELIZABETH ANDREA (RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANDREA
Last Name:BLOW
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANDREA
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3788
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38303-3788
Mailing Address - Country:US
Mailing Address - Phone:731-660-8730
Mailing Address - Fax:731-660-8739
Practice Address - Street 1:620 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3923
Practice Address - Country:US
Practice Address - Phone:731-541-5000
Practice Address - Fax:731-660-8739
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered