Provider Demographics
NPI:1629133822
Name:STRUB, ELIZABETH B (RD, LD,CDE)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:STRUB
Suffix:
Gender:F
Credentials:RD, LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WHITE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-7323
Mailing Address - Country:US
Mailing Address - Phone:828-645-5869
Mailing Address - Fax:
Practice Address - Street 1:35 WOODFIN ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3020
Practice Address - Country:US
Practice Address - Phone:828-250-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001895133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered