Provider Demographics
NPI:1689399354
Name:HEATHER ELIA RDN
Entity Type:Organization
Organization Name:HEATHER ELIA RDN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:248-701-9979
Mailing Address - Street 1:6642 LEYTONSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1200
Mailing Address - Country:US
Mailing Address - Phone:248-701-9979
Mailing Address - Fax:
Practice Address - Street 1:950 E MAPLE RD STE L10
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6482
Practice Address - Country:US
Practice Address - Phone:248-701-9979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty