Provider Demographics
NPI:1821568098
Name:ELLIOTT, DENISE MARIE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-8837
Mailing Address - Country:US
Mailing Address - Phone:812-760-4312
Mailing Address - Fax:
Practice Address - Street 1:1628 2ND ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3364
Practice Address - Country:US
Practice Address - Phone:270-564-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist