Provider Demographics
NPI:1760564421
Name:COGBURN, ELIZABETH GEORGANNA (RD, LDN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GEORGANNA
Last Name:COGBURN
Suffix:
Gender:F
Credentials:RD, LDN, IBCLC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:GEORGANNA COGBURN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD,LDN,IBCLC
Mailing Address - Street 1:20 RIDGE CROSS RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-9277
Mailing Address - Country:US
Mailing Address - Phone:828-298-6965
Mailing Address - Fax:
Practice Address - Street 1:119 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2868
Practice Address - Country:US
Practice Address - Phone:828-771-5500
Practice Address - Fax:828-771-5454
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000698133V00000X
NC192-10865174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL000698OtherNC BOARD OF DIETETICS/NUT