Provider Demographics
NPI:1629494026
Name:MAMMINA, ELIZABETH (RD, LDN, CDES)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MAMMINA
Suffix:
Gender:F
Credentials:RD, LDN, CDES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HARRISBURG PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-2935
Mailing Address - Fax:717-544-3935
Practice Address - Street 1:2150 HARRISBURG PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004383133V00000X
FLND9616133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered