Provider Demographics
NPI:1710947825
Name:GIAMIS, ELIZABETH LEIGH (MA, RD, LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LEIGH
Last Name:GIAMIS
Suffix:
Gender:F
Credentials:MA, RD, LDN, CDE
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:LEIGH
Other - Last Name:YACKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1231 HARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1128
Mailing Address - Country:US
Mailing Address - Phone:865-963-5675
Mailing Address - Fax:
Practice Address - Street 1:1231 HARWOOD DR
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1128
Practice Address - Country:US
Practice Address - Phone:865-963-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005679133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8162Medicare ID - Type Unspecified