Provider Demographics
NPI:1598901142
Name:SIEGMANN, ELIZABETH JO (RDN, LD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JO
Last Name:SIEGMANN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JO
Other - Last Name:HEDKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1721 CEDAR TRACE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-3902
Mailing Address - Country:US
Mailing Address - Phone:513-341-6511
Mailing Address - Fax:
Practice Address - Street 1:1721 CEDAR TRACE DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-3902
Practice Address - Country:US
Practice Address - Phone:513-341-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMT04251Medicare PIN