Provider Demographics
NPI:1922454511
Name:OWENS, ELIZABETH C (LDN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:C
Last Name:OWENS
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:CREDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDN
Mailing Address - Street 1:5828 ROBINS NEST LN
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3118
Mailing Address - Country:US
Mailing Address - Phone:716-474-2135
Mailing Address - Fax:
Practice Address - Street 1:5276 LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1688
Practice Address - Country:US
Practice Address - Phone:703-323-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3682133N00000X
DCNU100000183133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist