Provider Demographics
NPI:1790203701
Name:JONES, ELIZABETH (MS, RD, CDE)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CHMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CDE
Mailing Address - Street 1:2160 S FIRST AVE - BUILDING 150, LOC 3RD FLOOR MEDICAL
Mailing Address - Street 2:
Mailing Address - City:2160 S FIRST AVE
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-9103
Mailing Address - Fax:708-216-8057
Practice Address - Street 1:2160 S 1ST AVE BLDG 150
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-9103
Practice Address - Fax:708-216-8057
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered