Provider Demographics
NPI:1659155661
Name:ROWDEN, ELIZABETH LASSEN (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LASSEN
Last Name:ROWDEN
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 HOSPITAL WAY BLDG D
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5096
Mailing Address - Country:US
Mailing Address - Phone:208-239-2070
Mailing Address - Fax:208-239-3719
Practice Address - Street 1:957 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5096
Practice Address - Country:US
Practice Address - Phone:208-239-2070
Practice Address - Fax:208-239-3719
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1435133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered