Provider Demographics
NPI:1821561820
Name:MARSHALL, ELIZABETH (RDN, LD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E PARK BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5472
Mailing Address - Country:US
Mailing Address - Phone:972-422-9180
Mailing Address - Fax:888-821-2292
Practice Address - Street 1:700 E PARK BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5472
Practice Address - Country:US
Practice Address - Phone:972-422-9180
Practice Address - Fax:888-821-2292
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85044133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX403196501Medicaid