Provider Demographics
NPI:1710295894
Name:DENNIS, ELIZABETH JOHNSTON (RD, LD, MPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOHNSTON
Last Name:DENNIS
Suffix:
Gender:F
Credentials:RD, LD, MPH
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 PLEASANT ST
Practice Address - Street 2:STE 2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3863
Practice Address - Country:US
Practice Address - Phone:603-219-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0561133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered