Provider Demographics
NPI:1639256324
Name:NORTH, ELIZABETH LYNN (RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNN
Last Name:NORTH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1650 COCHRANE CIRCLE
Mailing Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-526-7968
Mailing Address - Fax:719-526-7968
Practice Address - Street 1:1650 COCHRANE CIRCLE
Practice Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-7968
Practice Address - Fax:719-526-7968
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXDT05532133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered