Provider Demographics
NPI:1710633284
Name:OSSORIO, ELLEN MITCHELL (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MITCHELL
Last Name:OSSORIO
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-9666
Mailing Address - Country:US
Mailing Address - Phone:901-590-8286
Mailing Address - Fax:
Practice Address - Street 1:108 SORORITY ROW
Practice Address - Street 2:
Practice Address - City:UNIVERISTY
Practice Address - State:MS
Practice Address - Zip Code:38677
Practice Address - Country:US
Practice Address - Phone:901-590-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD2185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered