Provider Demographics
NPI:1689184111
Name:PAGE, ELIZABETH G (RDN, CNSC, LDN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:PAGE
Suffix:
Gender:F
Credentials:RDN, CNSC, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S GREEN ST APT 702A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3719
Mailing Address - Country:US
Mailing Address - Phone:240-304-6488
Mailing Address - Fax:904-854-0750
Practice Address - Street 1:520 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1022
Practice Address - Country:US
Practice Address - Phone:708-660-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1026045133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered