Provider Demographics
NPI:1942397658
Name:HOLM, ELIZABETH MARKLEY
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARKLEY
Last Name:HOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:JANE
Other - Last Name:MARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:6400 BOULEVARD VW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1413
Mailing Address - Country:US
Mailing Address - Phone:703-660-9615
Mailing Address - Fax:
Practice Address - Street 1:517 WYTHE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1917
Practice Address - Country:US
Practice Address - Phone:703-660-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered